PACE Benefit Table
Program of All-Inclusive Care for the Elderly (PACE) Benefit Table
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.
Re-Pricing Medicare Inpatient Hospital Claims
Since July 1, 1991, the MO HealthNet Division (MHD) has been re-pricing Medicare Part A inpatient hospital crossover claims for the possible payment of Medicare deductible and co-insurance amounts. This Hot Tip is a reminder that the re-pricing policy also applies to Medicare Part C/Advantage plans for inpatient hospital services for deductible, co-insurance and co-pay amounts for participants who are QMB eligible.
Reporting Sequestration for Medicare Part C Plans
On April 1, 2013, The Centers for Medicare and Medicaid Services (CMS) imposed a mandatory 2% reduction in the Medicare Fee-for-Service (FFS) Program, also known as “Sequestration.” Sequestration reductions were reflected on the Medicare Explanation of Benefits (EOB) as Claim Adjustment Reason Code (CARC) number 223. This action affects FFS claims with dates of service or dates of discharge on or after April 1, 2013.