173-50-03 Enrollment process.

(A) Oversight:

(1) ODA manages the enrollment for PACE.

(2) ODA determines if a slot is available in PACE in which to enroll an applicant.

(3) ODA reserves the right to restrict enrollment based upon funding appropriated to ODA for PACE.

(4) ODA reserves the right to increase or decrease the maximum number of PACE slots.

(B) Enrollment process, in general:

(1) To begin the enrollment process, a person may apply through either a CDJFS or a PACE organization.

(2) The CDJFS and the PACE organization shall coordinate efforts regarding the enrollment process.

(1) The applicant shall complete form JFS 07200 and form JFS 02398 (or, instead of form JFS 02398, form JFS 02399).

(2) After form JFS 07200 is completed, the CDJFS shall determine if the applicant meets the financial eligibility criteria for medicaid that are specified in Chapters 5101:1-37 to 5101:1-42 of the Administrative Code.

(3) If the CDJFS determines that the applicant does not meet the financial eligibility criteria, it shall send a notice of denial and appeal rights to the applicant (or the authorized representative), as specified in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code. It shall also send a notice of denial to ODA and the PACE organization.

(4) The CDJFS may help the applicant complete, or partially complete, form JFS 02398 (or form JFS 02399). Afterwards, it shall forward the form (or the information on the form) to the PACE organization.

(5) Once a PACE organization receives the form (or the information from the form), it shall contact the applicant to complete the form, if necessary, and to provide the applicant with an in-person assessment to determine eligibility for PACE.

(6) Once the in-person assessment is fully completed, the PACE organization shall forward the information from its assessment to ODA.

(7) After receiving the information, ODA shall determine if the applicant meets the eligibility criteria specified in rule 173-50-02 of the Administrative Code.

(8) If ODA determines that an applicant meets the eligibility criteria, then:

(a) ODA shall notify the PACE organization of its determination.

(b) Once the PACE organization receives the determination from ODA, it shall notify the applicant (or the authorized representative) of the approval of enrollment into PACE and provide the applicant (or the authorized representative) with an enrollment agreement to sign.

(c) In order to be enrolled into the program, the applicant shall sign the enrollment agreement and return it to the PACE organization.

(d) The applicant’s enrollment into PACE is effective the first day of the month following the date that ODA determined that the applicant met the eligibility criteria and the PACE organization received the signed enrollment agreement.

(9) If ODA determines that an applicant does not meet the eligibility criteria, then:

(a) ODA shall notify the PACE organization of its determination.

(b) ODA shall provide the applicant (or the authorized representative) with a notice of denial and appeal rights, as specified in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code.

(D) Enrollment process when a person initially contacts a PACE organization to apply for PACE:

(1) The PACE organization shall provide the applicant with an in-person assessment to determine eligibility.

(2) The PACE organization may help the applicant apply for medicaid financial eligibility or may help the applicant complete form JFS 07200 and may secure the applicant’s signature (or authorized representative’s signature) for form JFS 02398 (or, instead of form JFS 02398, form JFS 02399). The PACE organization may submit the forms to the CDJFS on the applicant’s behalf.

(3) After form JFS 07200 is received, the CDJFS shall determine if the applicant meets the financial eligibility criteria for medicaid that are specified in Chapters 5101:1-37 to 5101:1-42 of the Administrative Code.

(4) If the CDJFS determines that the applicant does not meet the financial eligibility criteria, it shall send a notice of denial and appeal rights to the applicant (or the authorized representative), as specified in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code. It shall also send a notice of denial to ODA and the PACE organization.

(5) After completing the in-person assessment, the PACE organization shall submit the information from its assessment to ODA.

(6) After receiving the information, ODA shall determine if the applicant meets the eligibility criteria specified in rule 173-50-02 of the Administrative Code.

(7) If ODA determines that an applicant meets the eligibility criteria, then:

(a) ODA shall notify the PACE organization of its determination.

(c) In order to be enrolled into the program, the applicant shall sign the enrollment agreement and return it to the PACE organization.

(d) The applicant’s enrollment into PACE is effective the first day of the month following the date that ODA determines the applicant meets the eligibility criteria and the PACE organization received the signed enrollment agreement.

(8) If ODA determines that an applicant does not meet the eligibility criteria, then:

(a) ODA shall notify the PACE organization of its determination.

(b) ODA shall provide the applicant (or the authorized representative) with a notice of denial and appeal rights, as specified in Chapters 5101:6-1 to 5101:6-9 of the Administrative Code.

(E) Waiting lists:

(1) If an applicant meets the non-financial eligibility criteria for enrollment into PACE, but a slot in the program is not available, the PACE organization shall place the applicant on a waiting list.

(2) The PACE organization shall place applicants on the waiting list according to the date each applicant signs form JFS 02398 (or form JFS 02399) or the date that all non-financial eligibility criteria is met, whichever date is earlier.

(3) Once a slot becomes available, the PACE organization shall enroll an applicant on the waiting list according to the chronological order established under paragraph (E)(2) of this rule. If the next applicant on the waiting list is not ready to enroll in PACE, the PACE organization may enroll the next person on the waiting list who is ready.

(F) Definitions:

(1) “JFS 02398 ‘Request for Program of All-Inclusive Care for the Elderly Services’” (“JFS 02398”) means the form a CDJFS may use to refer an applicant to a PACE organization.

(2) “JFS 02399 ‘Home and Community Based Services Waiver Referral’” (“JFS 02399”) means the form a CDJFS may use to refer an applicant to a PACE organization.

(3) “JFS 07200 ‘Request for Cash, Medical, and Food Stamp Assistance’” (“JFS 07200”) means the form a CDJFS uses to determine if an applicant is eligible for medicaid.

Effective: 03/28/2009

R.C. 119.032 review dates: 02/27/2013

Promulgated Under: 119.03

Statutory Authority: 173.02

Rule Amplifies: 173.50