PACE Regulation and Guidance
The State Medicaid plan is the contract between the States and the Federal government under which States agree to administer the Medicaid program in accordance with Federal law and policy. The State plan preprint sets forth the scope of the Medicaid program, including groups covered, services furnished, and payment policy. When a State wants to change its State Medicaid plan, the State submits a ‘‘State Plan Amendment’’ (SPA), which must be approved by CMS in order for the State to receive Federal matching funds for the amended plan.
Section 1905(a)(26) of the Act, as added by Section 4802(a)(1) of the Balanced Budget Act (BBA), provides authority for States to elect PACE as an optional Medicaid benefit. The State plan electing the optional PACE program must be approved before CMS can approve an application for a PACE organization in that State.
To aid States in modifying their State plans, the CMS Center for Medicaid and State Operations developed an interim State plan preprint for PACE. A State Medicaid letter dated March 23, 1998, provided information and guidance to State Medicaid agencies on how to satisfy the SPA requirement. Additional directions for completing the SPA were provided in a State Medicaid Director letter that was issued November 9, 2000. The most current version of the State Plan preprint is available on the CMS PACE webpage.
PACE Provider Manual
This policy applies to operational PACE programs and providers who may be interested in developing a PACE Program in South Carolina. It also addresses operational issues for SCDHHS who serves as the State Administering Agency for PACE in South Carolina.
The following policies and procedures provide guidance to PACE Programs in accordance with all Federal regulations applicable to PACE Programs and all operational policies and procedures of SCDHHS and Medicaid. It is not the intent of the state policies to duplicate those outlined in the federal regulations but rather provide state-specific guidance to PACE programs operating in South Carolina. Please refer to the CMS PACE webpage for more information.