Actions Regarding All Inclusive Care for the Elderly (PACE)

PUBLIC NOTICE: 
SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

The South Carolina Department of Health and Human Services (SCDHHS), pursuant to the requirements of 42 CFR Section 447.205, gives notice of the following actions regarding its methods and standards for setting payment rates for the Program of All Inclusive Care for the Elderly (PACE) under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective for services provided on or after November 1, 2013, SCDHHS will amend the South Carolina Title XIX reimbursement methodology for the PACE program by developing capitation rates gross of patient liability and processing net payments to each PACE organization for each enrollee based on their respective patient liability amount in accordance with CMS regulations as detailed in the PACE capitation rate checklist. In addition to the methodology change, SCDHHS also updated the PACE upper payment limit and capitation rate calculation to incorporate more recent data and assumptions.

SCDHHS projects that based upon these actions, the new PACE per member per month capitation rates will be $2,605.01 for dual eligible enrollees and $3,973.39 for Medicaid only enrollees before reduction for patient liability, if applicable.  This will result in a projected increase in annual expenditures of approximately $729,355, or a 13.1% and 7.4% rate increase for dual eligible and Medicaid only participants, respectively after reduction for patient liability when applicable.  Projected annual expenditures are based on estimated patient liability amounts.  Actual costs will be dependent on each contracted PACE organization’s enrolled population and their actual patient liability amounts.  

Copies of this notice are available at each County Department of Health and Human Services Office and at www.scdhhs.gov for public review.  Additional information concerning the action is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Health Services, Room 800-36, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.

Print Version

Report Fraud