{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-330.3.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-330.3.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-330.3.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-330.3.html"}],"law_id":67859,"edition_id":1,"section_id":67859,"structure_id":13276,"section_number":"32.1-330.3","catch_line":"Operation of a PACE plan; oversight by Department of Medical Assistance Services","history":"1997, cc. 414, 475; 1998, c. 318; 2012, cc. 803, 835; 2019, c. 419; 2020, cc. 304, 365.","full_text":"A\n\nAs used in this section, unless the context requires a different meaning, “PACE” means of or associated with long-term care health plans (i) authorized as programs of all-inclusive care for the elderly by Subtitle I (§ 4801 et seq.) of Chapter 6 of Title IV of the Balanced Budget Act of 1997, Pub. L. No. 105-33, 111 Stat. 528 et seq., §§ 4801-4804, 1997, pursuant to Title XVIII and Title XIX of the United States Social Security Act (42 U.S.C. § 1395eee et seq.), and the state plan for medical assistance services as established pursuant to Chapter 10 (§ 32.1-323 et seq.) and (ii) which have signed agreements with the Department of Medical Assistance Services as long-term care health plans.B\n\nOperation of a PACE plan that participates in the medical assistance services program shall be in accordance with a prepaid health plan contract or other PACE contract consistent with Chapter 6 of Title IV of the federal Balanced Budget Act of 1997 with the Department of Medical Assistance Services.C\n\nAll contracts and subcontracts shall contain an agreement to hold harmless the Department of Medical Assistance Services and PACE enrollees in the event that a PACE provider cannot or will not pay for services performed by the subcontractor pursuant to the contract or subcontract.D\n\nDuring the PACE period, the plan shall have a fiscally sound operation as demonstrated by total assets being greater than total unsubordinated liabilities, sufficient cash flow and adequate liquidity to meet obligations as they become due, and a plan for handling insolvency approved by the Department of Medical Assistance Services.E\n\nThe PACE plan must demonstrate that it has arrangements in place in the amount of, at least, the sum of the following to cover expenses in the event of insolvency:1\n\nOne month’s total capitation revenue to cover expenses the month prior to insolvency; and2\n\nOne month’s average payment of operating expenses to cover potential expenses the month after the date of insolvency has been declared or operations cease.\n\t\t\t\tThe required arrangements to cover expenses shall be in accordance with the PACE Protocol as published by On Lok, Inc., in cooperation with the Centers for Medicare and Medicaid Services, as of April 14, 1995, or any successor protocol that may be agreed upon between the Centers for Medicare and Medicaid Services and On Lok, Inc.\n\t\t\t\tAppropriate arrangements to cover expenses shall include one or more of the following: reasonable and sufficient net worth, insolvency insurance, letters of credit, or parental guarantees.F\n\nEnrollment in a PACE plan shall be restricted to those individuals who participate in programs authorized pursuant to Title XIX or Title XVIII of the United States Social Security Act, respectively.G\n\nFull disclosure shall be made to all individuals in the process of enrolling in the PACE plan that services are not guaranteed beyond a 30-day period.H\n\nThe Board of Medical Assistance Services shall establish a Transitional Advisory Group to determine license requirements, regulations, and ongoing oversight. The Advisory Group shall include representatives from each of the following organizations: Department of Medical Assistance Services, Department of Social Services, Department of Health, Bureau of Insurance, Board of Medicine, Board of Pharmacy, Department for Aging and Rehabilitative Services, and a PACE provider.I\n\nThe Department shall develop and implement a coordinated plan to provide choice and education about the PACE program. The plan shall ensure that:1\n\nInformation about the availability and potential benefits of participating in the PACE program is provided to all eligible long-term services and supports clients as part of the long-term services and supports screening process pursuant to § 32.1-330. The client’s choice regarding participation in the PACE program shall be documented on the state long-term services and supports screening authorization form. The Department shall provide initial and ongoing training of all long-term services and supports screening teams on the PACE program.2\n\nThe Department develops informational materials and correspondence, including the initial and annual enrollment letters, for use by the Department and its contractors to educate and notify potentially eligible clients about long-term services and supports. These informational materials shall include the following:\n\t\t\t\ta. A description of the PACE program;\n\t\t\t\tb. A statement that an eligible individual has the option to enroll in the PACE program or be automatically enrolled in a managed care organization; and\n\t\t\t\tc. Contact information for PACE providers.","order_by":null,"text":{"0":{"id":245758,"text":"As used in this section, unless the context requires a different meaning, “PACE” means of or associated with long-term care health plans (i) authorized as programs of all-inclusive care for the elderly by Subtitle I (§ 4801 et seq.) of Chapter 6 of Title IV of the Balanced Budget Act of 1997, Pub. L. No. 105-33, 111 Stat. 528 et seq., §§ 4801-4804, 1997, pursuant to Title XVIII and Title XIX of the United States Social Security Act (42 U.S.C. § 1395eee et seq.), and the state plan for medical assistance services as established pursuant to Chapter 10 (§ 32.1-323 et seq.) and (ii) which have signed agreements with the Department of Medical Assistance Services as long-term care health plans.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":245759,"text":"Operation of a PACE plan that participates in the medical assistance services program shall be in accordance with a prepaid health plan contract or other PACE contract consistent with Chapter 6 of Title IV of the federal Balanced Budget Act of 1997 with the Department of Medical Assistance Services.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":245760,"text":"All contracts and subcontracts shall contain an agreement to hold harmless the Department of Medical Assistance Services and PACE enrollees in the event that a PACE provider cannot or will not pay for services performed by the subcontractor pursuant to the contract or subcontract.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":245761,"text":"During the PACE period, the plan shall have a fiscally sound operation as demonstrated by total assets being greater than total unsubordinated liabilities, sufficient cash flow and adequate liquidity to meet obligations as they become due, and a plan for handling insolvency approved by the Department of Medical Assistance Services.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":245762,"text":"The PACE plan must demonstrate that it has arrangements in place in the amount of, at least, the sum of the following to cover expenses in the event of insolvency:","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"E1"},"5":{"id":245763,"text":"One month’s total capitation revenue to cover expenses the month prior to insolvency; and","type":"section","prefixes":["E","1"],"prefix":"1","entire_prefix":"E1","prefix_anchor":"E1","level":2,"prior_prefix":"E","next_prefix":"E2"},"6":{"id":245764,"text":"One month’s average payment of operating expenses to cover potential expenses the month after the date of insolvency has been declared or operations cease.\n\t\t\t\tThe required arrangements to cover expenses shall be in accordance with the PACE Protocol as published by On Lok, Inc., in cooperation with the Centers for Medicare and Medicaid Services, as of April 14, 1995, or any successor protocol that may be agreed upon between the Centers for Medicare and Medicaid Services and On Lok, Inc.\n\t\t\t\tAppropriate arrangements to cover expenses shall include one or more of the following: reasonable and sufficient net worth, insolvency insurance, letters of credit, or parental guarantees.","type":"section","prefixes":["E","2"],"prefix":"2","entire_prefix":"E2","prefix_anchor":"E2","level":2,"prior_prefix":"E1","next_prefix":"F"},"7":{"id":245765,"text":"Enrollment in a PACE plan shall be restricted to those individuals who participate in programs authorized pursuant to Title XIX or Title XVIII of the United States Social Security Act, respectively.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E2","next_prefix":"G"},"8":{"id":245766,"text":"Full disclosure shall be made to all individuals in the process of enrolling in the PACE plan that services are not guaranteed beyond a 30-day period.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F","next_prefix":"H"},"9":{"id":245767,"text":"The Board of Medical Assistance Services shall establish a Transitional Advisory Group to determine license requirements, regulations, and ongoing oversight. The Advisory Group shall include representatives from each of the following organizations: Department of Medical Assistance Services, Department of Social Services, Department of Health, Bureau of Insurance, Board of Medicine, Board of Pharmacy, Department for Aging and Rehabilitative Services, and a PACE provider.","type":"section","prefixes":["H"],"prefix":"H","entire_prefix":"H","prefix_anchor":"H","level":1,"prior_prefix":"G","next_prefix":"I"},"10":{"id":245768,"text":"The Department shall develop and implement a coordinated plan to provide choice and education about the PACE program. The plan shall ensure that:","type":"section","prefixes":["I"],"prefix":"I","entire_prefix":"I","prefix_anchor":"I","level":1,"prior_prefix":"H","next_prefix":"I1"},"11":{"id":245769,"text":"Information about the availability and potential benefits of participating in the PACE program is provided to all eligible long-term services and supports clients as part of the long-term services and supports screening process pursuant to § 32.1-330. The client’s choice regarding participation in the PACE program shall be documented on the state long-term services and supports screening authorization form. The Department shall provide initial and ongoing training of all long-term services and supports screening teams on the PACE program.","type":"section","prefixes":["I","1"],"prefix":"1","entire_prefix":"I1","prefix_anchor":"I1","level":2,"prior_prefix":"I","next_prefix":"I2"},"12":{"id":245770,"text":"The Department develops informational materials and correspondence, including the initial and annual enrollment letters, for use by the Department and its contractors to educate and notify potentially eligible clients about long-term services and supports. These informational materials shall include the following:\n\t\t\t\ta. A description of the PACE program;\n\t\t\t\tb. A statement that an eligible individual has the option to enroll in the PACE program or be automatically enrolled in a managed care organization; and\n\t\t\t\tc. Contact information for PACE providers.","type":"section","prefixes":["I","2"],"prefix":"2","entire_prefix":"I2","prefix_anchor":"I2","level":2,"prior_prefix":"I1"}},"ancestry":[{"id":13276,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":13275,"metadata":{},"date_created":"2026-06-26 03:44:33","date_modified":"2026-06-26 03:44:33","permalink":{"id":201355,"object_type":"structure","relational_id":13276,"identifier":"1","token":"32.1\/10\/1","url":"\/32.1\/10\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13275,"edition_id":1,"name":"Department of Medical Assistance Services","identifier":"10","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:44:33","date_modified":"2026-06-26 03:44:33","permalink":{"id":201353,"object_type":"structure","relational_id":13275,"identifier":"10","token":"32.1\/10","url":"\/32.1\/10\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":75748,"structure_id":13276,"section_number":"32.1-323","catch_line":"Department of Medical Assistance Services","url":"\/32.1-323\/","token":"32.1\/10\/1\/32.1-323","metadata":false},{"id":73079,"structure_id":13276,"section_number":"32.1-323.1","catch_line":"Department to submit forecast of expenditures","url":"\/32.1-323.1\/","token":"32.1\/10\/1\/32.1-323.1","metadata":false},{"id":78209,"structure_id":13276,"section_number":"32.1-323.2","catch_line":"Elimination of waiting lists for certain waivers","url":"\/32.1-323.2\/","token":"32.1\/10\/1\/32.1-323.2","metadata":false},{"id":65434,"structure_id":13276,"section_number":"32.1-323.3","catch_line":"Dependents of foreign service members; waiting lists for certain waivers","url":"\/32.1-323.3\/","token":"32.1\/10\/1\/32.1-323.3","metadata":false},{"id":74370,"structure_id":13276,"section_number":"32.1-323.4","catch_line":"Department to facilitate transition of persons between certain waiver programs","url":"\/32.1-323.4\/","token":"32.1\/10\/1\/32.1-323.4","metadata":false},{"id":56444,"structure_id":13276,"section_number":"32.1-324","catch_line":"Board of Medical Assistance Services","url":"\/32.1-324\/","token":"32.1\/10\/1\/32.1-324","metadata":false},{"id":82951,"structure_id":13276,"section_number":"32.1-324.1","catch_line":"Authority to administer oaths, conduct hearings; obtaining relevant documents and other information","url":"\/32.1-324.1\/","token":"32.1\/10\/1\/32.1-324.1","metadata":false},{"id":68172,"structure_id":13276,"section_number":"32.1-324.2","catch_line":"Director to facilitate communication","url":"\/32.1-324.2\/","token":"32.1\/10\/1\/32.1-324.2","metadata":false},{"id":75151,"structure_id":13276,"section_number":"32.1-324.3","catch_line":"Uninsured Medical Catastrophe Fund established","url":"\/32.1-324.3\/","token":"32.1\/10\/1\/32.1-324.3","metadata":false},{"id":77747,"structure_id":13276,"section_number":"32.1-325","catch_line":"Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers","url":"\/32.1-325\/","token":"32.1\/10\/1\/32.1-325","metadata":false},{"id":76231,"structure_id":13276,"section_number":"32.1-325.001","catch_line":"Repealed","url":"\/32.1-325.001\/","token":"32.1\/10\/1\/32.1-325.001","metadata":false},{"id":83706,"structure_id":13276,"section_number":"32.1-325.01","catch_line":"Certain term life insurance considered resources","url":"\/32.1-325.01\/","token":"32.1\/10\/1\/32.1-325.01","metadata":false},{"id":54270,"structure_id":13276,"section_number":"32.1-325.02","catch_line":"Determinations of assets; disclaimers of interests to be considered uncompensated transfers of assets for Medicaid eligibility purposes under certain circumstances","url":"\/32.1-325.02\/","token":"32.1\/10\/1\/32.1-325.02","metadata":false},{"id":73332,"structure_id":13276,"section_number":"32.1-325.03","catch_line":"Legal presence required for certain state and local public benefits; exceptions; definitions; proof of legal presence","url":"\/32.1-325.03\/","token":"32.1\/10\/1\/32.1-325.03","metadata":false},{"id":83713,"structure_id":13276,"section_number":"32.1-325.04","catch_line":"Eligibility for medical assistance; individuals confined in state correctional facilities","url":"\/32.1-325.04\/","token":"32.1\/10\/1\/32.1-325.04","metadata":false},{"id":75066,"structure_id":13276,"section_number":"32.1-325.1","catch_line":"Appeals of agency determinations","url":"\/32.1-325.1\/","token":"32.1\/10\/1\/32.1-325.1","metadata":false},{"id":87103,"structure_id":13276,"section_number":"32.1-325.1:1","catch_line":"Definitions; recovery of overpayment for medical assistance services","url":"\/32.1-325.1_1\/","token":"32.1\/10\/1\/32.1-325.1_1","metadata":false},{"id":56047,"structure_id":13276,"section_number":"32.1-325.2","catch_line":"Department is payor of last resort","url":"\/32.1-325.2\/","token":"32.1\/10\/1\/32.1-325.2","metadata":false},{"id":60758,"structure_id":13276,"section_number":"32.1-325.3","catch_line":"Disclosure or use of information for purpose not connected with medical assistance program; Department not subject to certain disclosure","url":"\/32.1-325.3\/","token":"32.1\/10\/1\/32.1-325.3","metadata":false},{"id":55595,"structure_id":13276,"section_number":"32.1-325.4","catch_line":"Penalty for violation","url":"\/32.1-325.4\/","token":"32.1\/10\/1\/32.1-325.4","metadata":false},{"id":60835,"structure_id":13276,"section_number":"32.1-325.5","catch_line":"State pharmacy benefits manager","url":"\/32.1-325.5\/","token":"32.1\/10\/1\/32.1-325.5","metadata":false},{"id":62094,"structure_id":13276,"section_number":"32.1-326","catch_line":"Director may make payments to or for eligible persons in state-owned medical facilities","url":"\/32.1-326\/","token":"32.1\/10\/1\/32.1-326","metadata":false},{"id":75399,"structure_id":13276,"section_number":"32.1-326.1","catch_line":"Department to operate program of estate recovery","url":"\/32.1-326.1\/","token":"32.1\/10\/1\/32.1-326.1","metadata":false},{"id":86309,"structure_id":13276,"section_number":"32.1-326.2","catch_line":"Pilot school\/community health centers","url":"\/32.1-326.2\/","token":"32.1\/10\/1\/32.1-326.2","metadata":false},{"id":69227,"structure_id":13276,"section_number":"32.1-326.3","catch_line":"Special education health services; memorandum of agreement between the Department of Education and the Department of Medical Assistance Services","url":"\/32.1-326.3\/","token":"32.1\/10\/1\/32.1-326.3","metadata":false},{"id":81598,"structure_id":13276,"section_number":"32.1-327","catch_line":"Claim against indigent's estate for payments made","url":"\/32.1-327\/","token":"32.1\/10\/1\/32.1-327","metadata":false},{"id":59946,"structure_id":13276,"section_number":"32.1-328","catch_line":"Repealed","url":"\/32.1-328\/","token":"32.1\/10\/1\/32.1-328","metadata":false},{"id":74371,"structure_id":13276,"section_number":"32.1-329","catch_line":"Repealed","url":"\/32.1-329\/","token":"32.1\/10\/1\/32.1-329","metadata":false},{"id":85726,"structure_id":13276,"section_number":"32.1-330","catch_line":"Long-term services and supports screening required","url":"\/32.1-330\/","token":"32.1\/10\/1\/32.1-330","metadata":false},{"id":80319,"structure_id":13276,"section_number":"32.1-330.01","catch_line":"Reports related to long-term services and supports","url":"\/32.1-330.01\/","token":"32.1\/10\/1\/32.1-330.01","metadata":false},{"id":56351,"structure_id":13276,"section_number":"32.1-330.02","catch_line":"Average hourly payment rates; publication","url":"\/32.1-330.02\/","token":"32.1\/10\/1\/32.1-330.02","metadata":false},{"id":75895,"structure_id":13276,"section_number":"32.1-330.1","catch_line":"Department to implement premium assistance program for HIV-positive individuals","url":"\/32.1-330.1\/","token":"32.1\/10\/1\/32.1-330.1","metadata":false},{"id":67982,"structure_id":13276,"section_number":"32.1-330.2","catch_line":"Medicaid managed care programs; program information documents; plain language required","url":"\/32.1-330.2\/","token":"32.1\/10\/1\/32.1-330.2","metadata":false},{"id":67859,"structure_id":13276,"section_number":"32.1-330.3","catch_line":"Operation of a PACE plan; oversight by Department of Medical Assistance Services","url":"\/32.1-330.3\/","token":"32.1\/10\/1\/32.1-330.3","metadata":false},{"id":85218,"structure_id":13276,"section_number":"32.1-330.4","catch_line":"Uniform assessment instrument for PACE plans","url":"\/32.1-330.4\/","token":"32.1\/10\/1\/32.1-330.4","metadata":false},{"id":56407,"structure_id":13276,"section_number":"32.1-330.5","catch_line":"Reports related to eligibility renewal","url":"\/32.1-330.5\/","token":"32.1\/10\/1\/32.1-330.5","metadata":false},{"id":59199,"structure_id":13276,"section_number":"32.1-331","catch_line":"Repealed","url":"\/32.1-331\/","token":"32.1\/10\/1\/32.1-331","metadata":false},{"id":60720,"structure_id":13276,"section_number":"32.1-331.01","catch_line":"Health Care Coverage Assessment Fund","url":"\/32.1-331.01\/","token":"32.1\/10\/1\/32.1-331.01","metadata":false},{"id":76953,"structure_id":13276,"section_number":"32.1-331.02","catch_line":"Health Care Provider Payment Rate Assessment Fund","url":"\/32.1-331.02\/","token":"32.1\/10\/1\/32.1-331.02","metadata":false},{"id":79240,"structure_id":13276,"section_number":"32.1-331.03","catch_line":"Process for payment directly to nursing facility or ICF\/MR","url":"\/32.1-331.03\/","token":"32.1\/10\/1\/32.1-331.03","metadata":false},{"id":80605,"structure_id":13276,"section_number":"32.1-331.04","catch_line":"Personal care aides; orientation program","url":"\/32.1-331.04\/","token":"32.1\/10\/1\/32.1-331.04","metadata":false},{"id":84036,"structure_id":13276,"section_number":"32.1-331.05","catch_line":"Coordinated specialty care; work group","url":"\/32.1-331.05\/","token":"32.1\/10\/1\/32.1-331.05","metadata":false},{"id":77511,"structure_id":13276,"section_number":"32.1-331.06","catch_line":"Annual review of medications and treatment for sickle cell disease; report","url":"\/32.1-331.06\/","token":"32.1\/10\/1\/32.1-331.06","metadata":false}],"previous_section":{"id":67982,"structure_id":13276,"section_number":"32.1-330.2","catch_line":"Medicaid managed care programs; program information documents; plain language required","url":"\/32.1-330.2\/","token":"32.1\/10\/1\/32.1-330.2","metadata":false},"next_section":{"id":85218,"structure_id":13276,"section_number":"32.1-330.4","catch_line":"Uniform assessment instrument for PACE plans","url":"\/32.1-330.4\/","token":"32.1\/10\/1\/32.1-330.4","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-330.3\/","history_text":"

This law was first created in 1997. The record of its establishment is cataloged in chapters 414<\/a> and 475<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 4 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1998, chapter 318<\/a>; in 2012, chapters 803<\/a> and 835<\/a>; in 2019, chapter 419<\/a>; in 2020, chapters 304<\/a> and 365<\/a>.<\/p>","references":[{"id":85726,"section_number":"32.1-330","catch_line":"Long-term services and supports screening required","order_by":null,"url":"\/32.1-330\/"},{"id":85218,"section_number":"32.1-330.4","catch_line":"Uniform assessment instrument for PACE plans","order_by":null,"url":"\/32.1-330.4\/"},{"id":56483,"section_number":"54.1-3420.2","catch_line":"Delivery of prescription drug order","order_by":null,"url":"\/54.1-3420.2\/"}],"refers_to":[{"id":75748,"section_number":"32.1-323","catch_line":"Department of Medical Assistance Services","order_by":null,"url":"\/32.1-323\/"},{"id":85726,"section_number":"32.1-330","catch_line":"Long-term services and supports screening required","order_by":null,"url":"\/32.1-330\/"}],"permalink":{"id":201489,"object_type":"law","relational_id":67859,"identifier":"32.1-330.3","token":"32.1\/10\/1\/32.1-330.3","url":"\/32.1-330.3\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-330.3\/","token":"32.1\/10\/1\/32.1-330.3","dublin_core":{"Title":"Operation of a PACE plan; oversight by Department of Medical Assistance Services","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-330.3","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> As used in this section, unless the context requires a different meaning, “PACE<\/span>” means of or associated with long-term care health plans (i) authorized as programs of all-inclusive care for the elderly by Subtitle I (§ 4801 et seq.) of Chapter 6 of Title IV of the Balanced Budget Act of 1997, Pub. L. No. 105-33, 111 Stat. 528 et seq., §§ 4801-4804, 1997, pursuant to Title XVIII and Title XIX of the United States Social Security Act (42 U.S.C. § 1395eee et seq.), and the state plan for medical assistance services as established pursuant to Chapter 10 (§ 32.1-323<\/a> et seq.) and (ii) which have signed agreements with the Department<\/span> of Medical Assistance Services as long-term care health plans. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Operation of a PACE<\/span> plan that participates in the medical assistance services program shall be in accordance with a prepaid health plan contract<\/span> or other PACE<\/span> contract<\/span> consistent with Chapter 6 of Title IV of the federal Balanced Budget Act of 1997 with the Department<\/span> of Medical Assistance Services. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> All contracts<\/span> and subcontracts shall contain an agreement to hold harmless the Department<\/span> of Medical Assistance Services and PACE<\/span> enrollees in the event that a PACE<\/span> provider cannot or will not pay for services performed by the subcontractor pursuant to the contract<\/span> or subcontract. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> During the PACE<\/span> period, the plan shall have a fiscally sound operation as demonstrated by total assets<\/span> being greater than total unsubordinated liabilities, sufficient cash flow and adequate liquidity to meet obligations as they become due, and a plan for handling insolvency approved by the Department<\/span> of Medical Assistance Services. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> The PACE<\/span> plan must demonstrate that it has arrangements in place in the amount of, at least, the sum of the following to cover expenses in the event of insolvency: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> One month’s total capitation revenue to cover expenses the month prior to insolvency; and <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> One month’s average payment of operating expenses to cover potential expenses the month after the date of insolvency has been declared or operations cease.\n\t\t\t\tThe required arrangements to cover expenses shall be in accordance with the PACE<\/span> Protocol as published by On Lok, Inc., in cooperation with the Centers for Medicare and Medicaid Services, as of April 14, 1995, or any successor protocol that may be agreed upon between the Centers for Medicare and Medicaid Services and On Lok, Inc.\n\t\t\t\tAppropriate arrangements to cover expenses shall include one or more of the following: reasonable and sufficient net worth, insolvency insurance, letters of credit, or parental guarantees. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> Enrollment in a PACE<\/span> plan shall be restricted to those individuals who participate in programs authorized pursuant to Title XIX or Title XVIII of the United States Social Security Act, respectively. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> Full disclosure shall be made to all individuals in the process of enrolling in the PACE<\/span> plan that services are not guaranteed beyond a 30-day period. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

H.<\/span> The Board<\/span> of Medical Assistance Services shall establish a Transitional Advisory Group to determine license requirements, regulations, and ongoing oversight. The Advisory Group shall include representatives from each of the following organizations: Department<\/span> of Medical Assistance Services, Department<\/span> of Social Services, Department<\/span> of Health, Bureau of Insurance, Board<\/span> of Medicine, Board<\/span> of Pharmacy, Department<\/span> for Aging and Rehabilitative Services, and a PACE<\/span> provider. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

I.<\/span> The Department<\/span> shall develop and implement a coordinated plan to provide choice and education about the PACE<\/span> program. The plan shall ensure that: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Information about the availability and potential benefits of participating in the PACE<\/span> program is provided to all eligible long-term services and supports clients as part of the long-term services and supports screening process pursuant to § 32.1-330<\/a>. The client’s choice regarding participation in the PACE<\/span> program shall be documented on the state long-term services and supports screening authorization form. The Department<\/span> shall provide initial and ongoing training of all long-term services and supports screening teams on the PACE<\/span> program. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> The Department<\/span> develops informational materials<\/span> and correspondence, including the initial and annual enrollment letters, for use by the Department<\/span> and its contractors to educate and notify potentially eligible clients about long-term services and supports. These informational materials<\/span> shall include the following:\n\t\t\t\ta. A description of the PACE<\/span> program;\n\t\t\t\tb. A statement that an eligible individual has the option to enroll in the PACE<\/span> program or be automatically enrolled in a managed care organization; and\n\t\t\t\tc. Contact information for PACE<\/span> providers. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nOPERATION OF A PACE PLAN; OVERSIGHT BY DEPARTMENT OF MEDICAL ASSISTANCE SERVICES\n(\u00a7 32.1-330.3)\n\nA. As used in this section, unless the context requires a different meaning,\n“PACE” means of or associated with long-term care health plans (i)\nauthorized as programs of all-inclusive care for the elderly by Subtitle I\n(§ 4801 et seq.) of Chapter 6 of Title IV of the Balanced Budget Act of\n1997, Pub. L. No. 105-33, 111 Stat. 528 et seq., §§ 4801-4804, 1997,\npursuant to Title XVIII and Title XIX of the United States Social Security Act\n(42 U.S.C. § 1395eee et seq.), and the state plan for medical assistance\nservices as established pursuant to Chapter 10 (§ 32.1-323 et seq.) and\n(ii) which have signed agreements with the Department of Medical Assistance\nServices as long-term care health plans.\n\nB. Operation of a PACE plan that participates in the medical assistance services\nprogram shall be in accordance with a prepaid health plan contract or other PACE\ncontract consistent with Chapter 6 of Title IV of the federal Balanced Budget\nAct of 1997 with the Department of Medical Assistance Services.\n\nC. All contracts and subcontracts shall contain an agreement to hold harmless\nthe Department of Medical Assistance Services and PACE enrollees in the event\nthat a PACE provider cannot or will not pay for services performed by the\nsubcontractor pursuant to the contract or subcontract.\n\nD. During the PACE period, the plan shall have a fiscally sound operation as\ndemonstrated by total assets being greater than total unsubordinated\nliabilities, sufficient cash flow and adequate liquidity to meet obligations as\nthey become due, and a plan for handling insolvency approved by the Department\nof Medical Assistance Services.\n\nE. The PACE plan must demonstrate that it has arrangements in place in the\namount of, at least, the sum of the following to cover expenses in the event of\ninsolvency:\n\n 1. One month’s total capitation revenue to cover expenses the month\n prior to insolvency; and\n\n 2. One month’s average payment of operating expenses to cover potential\n expenses the month after the date of insolvency has been declared or\n operations cease.\n \t\t\t\tThe required arrangements to cover expenses shall be in accordance with\n the PACE Protocol as published by On Lok, Inc., in cooperation with the\n Centers for Medicare and Medicaid Services, as of April 14, 1995, or any\n successor protocol that may be agreed upon between the Centers for Medicare\n and Medicaid Services and On Lok, Inc.\n \t\t\t\tAppropriate arrangements to cover expenses shall include one or more of\n the following: reasonable and sufficient net worth, insolvency insurance,\n letters of credit, or parental guarantees.\n\nF. Enrollment in a PACE plan shall be restricted to those individuals who\nparticipate in programs authorized pursuant to Title XIX or Title XVIII of the\nUnited States Social Security Act, respectively.\n\nG. Full disclosure shall be made to all individuals in the process of enrolling\nin the PACE plan that services are not guaranteed beyond a 30-day period.\n\nH. The Board of Medical Assistance Services shall establish a Transitional\nAdvisory Group to determine license requirements, regulations, and ongoing\noversight. The Advisory Group shall include representatives from each of the\nfollowing organizations: Department of Medical Assistance Services, Department\nof Social Services, Department of Health, Bureau of Insurance, Board of\nMedicine, Board of Pharmacy, Department for Aging and Rehabilitative Services,\nand a PACE provider.\n\nI. The Department shall develop and implement a coordinated plan to provide\nchoice and education about the PACE program. The plan shall ensure that:\n\n 1. Information about the availability and potential benefits of participating\n in the PACE program is provided to all eligible long-term services and\n supports clients as part of the long-term services and supports screening\n process pursuant to § 32.1-330. The client’s choice regarding\n participation in the PACE program shall be documented on the state long-term\n services and supports screening authorization form. The Department shall\n provide initial and ongoing training of all long-term services and supports\n screening teams on the PACE program.\n\n 2. The Department develops informational materials and correspondence,\n including the initial and annual enrollment letters, for use by the Department\n and its contractors to educate and notify potentially eligible clients about\n long-term services and supports. These informational materials shall include\n the following:\n \t\t\t\ta. A description of the PACE program;\n \t\t\t\tb. A statement that an eligible individual has the option to enroll in the\n PACE program or be automatically enrolled in a managed care organization; and\n \t\t\t\tc. Contact information for PACE providers.\n\nHISTORY: 1997, cc. 414, 475; 1998, c. 318; 2012, cc. 803, 835; 2019, c. 419;\n2020, cc. 304, 365.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}