8350 Processing Deadlines - PACE payments are issued in advance and generated at the end of the previous month. The fiscal agent begins processing payments immediately following receipt of the monthly eligibility file from KEES. Changes coming after the monthly file may be processed, but payment to the PACE entity is delayed.

To ensure timely payments are made to the PACE entity, the eligibility worker must take special care when processing PACE cases. Every effort should be made to have eligibility changes for the following month completed prior to the medical card cutoff. However, to ensure that adequate notification is coming from the PACE provider, the following time frames have been established:

 

  1. Current Recipients – For a current Medicaid recipient, the date the PACE entity notifies the eligibility worker of PACE enrollment determines how the case is processed.

    1. If the PACE entity notifies the eligibility worker of PACE enrollment of a current Medicaid beneficiary by the 10th of the month, the eligibility worker will make every effort to process the case before the medical card cutoff for that month.

    2. If the PACE entity notifies the eligibility worker of PACE enrollment of a current Medicaid beneficiary between the 10th of the month and medical card cutoff, the eligibility worker will make every effort to process the case before the medical card cutoff for the month. If that is not possible, the case should be processed prior to the last day of the month.

    3. If the PACE entity notifies the eligibility worker of PACE enrollment of a current Medicaid beneficiary after the medical card cutoff for that month, the eligibility worker will make every effort to process the case before the last day of the month. In all situations, PACE coverage is effective the month after the month the case is processed and approved.

  2. New Applicants – If the PACE entity notifies the eligibility worker of PACE enrollment of a new Medicaid applicant, and the applicant is otherwise eligible for PACE, coverage is effective the month after the month the case is processed. The eligibility worker will make every effort to process the case before the medical card cutoff.

  3.  Exceptions – In rare instances, the eligibility worker may contact the KDADS PACE Program Manager for authorization to begin coverage prior to the month indicated in subsections (1) and (2) above. If an exception is granted, PACE coverage is effective the month authorized by the Program Manager. No exception may be processed by the eligibility worker until authorized by the Program Manager. Documentation of the decision to apply an earlier start date must be included in the case file.