US · guidance
CMS Pub. 100-11, ch. 13, § 30.2
County Rates
The prospective payment rates for PACE are based on the applicable amount under
section 1853(k)(1) of the Act, unadjusted for IME. The applicable amount is the pre-Affordable Care Act rate, which will be phased-out under the Affordable Care Act for
other Medicare Advantage plans. The applicable amount will not be phased out for
PACE. In rebasing years, this rate is the greater of: 1) the county’s FFS rate for the
payment year or 2) the prior year’s applicable amount increased by the payment year’s
National Per Capita Medicare Advantage Growth Percentage. In non-rebasing years, this
rate is the prior year’s applicable amount increased by the payment year’s National Per
Capita Medicare Advantage Growth Percentage.
Section 1853 (k)(4) of the Act requires CMS to phase out Indirect Medical Education
(IME) amounts from MA capitation rates. PACE programs are excluded from the IME
payment phase- out under that section.
Effective CY 2006 and subsequent years, CMS makes advance monthly per capita
payments for aged and disabled enrollees based on the bidding methodology established
by the MMA. PACE plans are not required to bid, however.
History
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
60ca81f498df17ef1039573462619f44c26fdb3664e2e13f1ef4dda840876658
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