Sec. 8. State option to expand eligibility for PACE program
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/bill/117/s/1162/is/section-8A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1934 of the Social Security Act ( 42 U.S.C. 1396u–4 ), as amended by section 3(b), is amended— in subsection (a)(5)(B), by inserting , subsection (k), and subsection
(l)after subsection (c)(4) ; and by adding at the end the following new subsection: A State described in paragraph
(3)may, at the option of the State, deem individuals described in paragraph
(2)to be PACE program eligible individuals for the purposes of this section without regard to the requirement under subsection (a)(5)(B) that a PACE program eligible individual require the level of care required under the State medicaid plan for coverage of nursing facility services. An individual is described in this paragraph if— the individual meets the requirements of subparagraphs (A), (C), and
(D)of subsection (a)(5); the individual is unable to perform at least 2 (or such higher number as the State may establish) activities of daily living, as determined by the State; and the individual's income does not exceed 150 percent of the poverty line (as defined in section 2110(c)(5)) or, if greater, the income level applicable for an individual who has been determined to require an institutional level of care to be eligible for nursing facility services under the State plan and with respect to whom there has been a determination that, but for the provision of such services, the individual would require the level of care provided in a hospital, a nursing facility, an intermediate care facility for the mentally retarded, or an institution for mental diseases, the cost of which could be reimbursed under the State plan. A State shall only be eligible to exercise the option under this subsection if— the State administering agency has entered into an agreement for the operation of a PACE program under this section (and section 1894, if applicable) among such agency, the Secretary, and a PACE provider; and the State provides coverage under the State plan under this title (or a waiver of such plan) for long-term services and supports. Notwithstanding section 1905(b), in the case of a State that exercises the option under this subsection, the Federal medical assistance percentage applicable with respect to expenditures by such State on monthly payments made to PACE providers under a PACE program agreement under this section for individuals who are deemed to be PACE program eligible individuals in accordance with paragraph
(2)shall be equal to 90 percent. . Section 1894(a)(5) of the Social Security Act ( 42 U.S.C. 1395eee(a)(5) ) is amended by inserting and section 1934(l) after subsection (c)(4) .
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- 42 USC 1396u–4
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