Haw. Code R. § 17-1746-15

Current through September, 2024

Section 17-1746-15 - Covered services

(a) Services available to PACE enrollees shall be negotiated by the department and the PACE provider. The cost of providing PACE services and the administrative costs for the PACE provider shall be included in the capitation payment.

(b) The covered services may be provided by the PACE provider either directly or indirectly through subcontractual arrangements in accordance with the provisions set forth in this chapter.

(c) At the minimum, PACE services shall include:

(1) Multidisciplinary team to assess, develop, implement and evaluate the treatment plan of each participant enrolled in PACE;

(2) Adult day health services of which the core services include health related services, nursing services, maintenance therapies, social work services, recreational therapy, and dietary services;

(3) Primary medical care including consultation, routine care, preventive health care, and physical examinations;

(4) Occupational therapy or physical therapy or both when prescribed by the multidisciplinary team;

(5) Audiology services when referred by the multidisciplinary team;

(6) Optometry services when referred by the multidisciplinary team;

(7) Dental care as determined by the PACE provider dentist and approved by the multidisciplinary team;

(8) Podiatry services;

(9) Speech therapy;

(10) Home care services;

(11) Prescription drug services;

(12) Durable medical equipment;

(13) Non-emergency medical and non-medical transportation; and

(14) Acuity level A and acuity level C nursing facility care.

(d) Prior authorization requirements applicable to fee for service providers shall be waived for PACE when such services are furnished by PACE to the PACE enrollees.

Haw. Code R. § 17-1746-15

[Eff 01/29/96] (Auth: SLH 1992, Act 211; HRS § 346-59; 42 C.F.R. §431.10) (Imp: HRS § 346-14; 42 C.F.R. §434.21)