PACE / PACENET PROGRAM

Program Changes

November 28, 2003

New PACE/PACENET legislation becomes law effective January 1, 2004.

This legislation, House Bill 888 (HB 888), is available on the internet at: http://www.legis.state.pa.us/cfdocs/legis/home/session.cfm?papowerNav=|

The most notable changes for providers are:

· dispensing fee increase for pharmacies to $4.00

· two-tiered (brand-generic) PACE copay

• potential increase of 100,000 older Pennsylvanians in PACE/PACENET

• PACENET deductible converts to a $40.00 monthly cumulative based on the Program’s calculated reimbursement amount

• all PACENET claims subject to all Program edits including DUR

• original claims must be received within 30 days of dispensing; re-bills remain at 90 days

• inclusion of Federal Upper Limit (FUL) pricing in the reimbursement calculation.

Some of these changes unquestionably impact PACE/PACENET providers.

However section I, A of the PACE/PACENET Provider Agreement states:

“The Provider agrees to participate in the PACE and PACENET Programs and in the course of such participation to comply with all Federal and Pennsylvania laws generally and specifically governing participation in the PACE and PACENET Programs. The Provider agrees to be knowledgeable of and comply with applicable rules, regulations, rates and fees schedules promulgated under such laws and any amendments thereto.”

The Department hopes that on January 1, 2004 all current PACE Providers will continue to participate in the new PACE/PACENET Program.

Providers wishing however, to end their participation before the new act becomes effective on January 1, 2004, must dis-enroll, in writing, prior to the effective date.

Questions may be directed to Provider Services at:

1-800-835-4080

PPB-03-015