Public Notice of Final Action for the Program of All-Inclusive Care for the Elderly (PACE)

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding the Program of All-Inclusive Care for the Elderly (PACE) program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective on or after July 1, 2021, SCDHHS will amend the South Carolina Title XIX State Plan to address compliance with the Centers for Medicare and Medicaid Services (CMS) rate setting guidance in establishing capitated rates for PACE programs. CMS requires that the rate setting methodology applied to PACE programs is consistent with the information in the State Plan, the three-way program agreement and the rate information submitted to CMS for approval. In review of the current proposed rate for 2021, CMS has identified information contained in the 2013 state plan amendment (SPA) that is not consistent with the rate methodology currently being applied to PACE programs. The updated SPA will correct the term “Upper Payment Limit” (UPL) and replace it with the term “As Would Otherwise have been Paid” (AWOP), which more accurately reflects the rate setting methodology now applied to PACE programs in determining the capitated payments.

Based on the actions above, SCDHHS anticipates this policy change to be budget neutral. Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at SCDHHS, Office of Health Programs, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.