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ACE Program
General Program Rules
- San Mateo ACE Provider Network. Services provided under the San Mateo ACE Program are only covered at the San Mateo Medical Center (SMMC) hospital and clinic system and the Ravenswood clinics except with referral and/or prior authorization.
- Emergency Care. Emergency services will not be covered under the San Mateo ACE Program except at San Mateo Medical Center, and claims for emergency services will be denied. Hospitals will continue to be responsible for covering emergency care to San Mateo ACE participants under their charity care and SB 12 requirements.
- Services Provided by Non-ACE Providers. Claims will not be paid for services provided by Non-ACE Providers, except with prior authorization. Authorization for medically necessary services will only be granted to non-ACE Providers who have service contracts with San Mateo County and the San Mateo Medical Center and whose services are referred by a San Mateo ACE Provider. Other criteria may also apply.
- Out-of-County Services. Services provided outside of San Mateo County will not be covered, except with prior authorization. The authorization rules described above for services provided by non-ACE Providers apply.
- Repatriation. San Mateo Medical Center will accept repatriation of San Mateo ACE Participants who are admitted into other hospitals for emergency care. Individuals must be in stable condition and fit for repatriation. Coordination with the SMMC medical management team is required. To repatriate a San Mateo ACE Participant, please contact SMMC’s Admitting Clerk at 650.573.2657.
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