Rule 173-50-04 | PACE: voluntary disenrollment.
(A) A participant may voluntarily disenroll from PACE at any time without cause.
(B) The PACE organization shall ensure its employees or contractors do not engage in any practice that would reasonably be expected to have the effect of steering or encouraging disenrollment of participants due to a change in health status.
(C) Process for voluntary disenrollment:
(1) A participant who wishes to voluntarily disenroll from PACE shall initiate the voluntary disenrollment process by informing the PACE organization verbally, electronically, or in writing.
(2) Once the PACE organization receives the participant's request, it shall provide the participant with a disenrollment form.
(3) Once the participant receives the disenrollment form, the participant shall sign the form and return it to the PACE organization.
(4) After the PACE organization receives the signed disenrollment form, it shall forward the form to ODA on the participant's behalf no later than one business day after receiving the form.
(5) A participant's voluntary disenrollment is effective on the first day of the month after the date the PACE organization receives the participant's notice of voluntary disenrollment.
(6) ODA shall notify the participant of the effective date in writing.
(7) After receiving a signed document from the PACE organization, ODA shall enter the disenrollment request in the ODA- and ODM-approved eligibility systems.
(D) After a participant initiates a voluntary disenrollment, the PACE organization shall do the following:
(1) Complete the mandates regarding the disenrollment form in paragraphs (C)(2) and (C)(4) of this rule.
(2) Continue to provide necessary services to the participant until the date of disenrollment.
(E) Before disenrollment, the PACE organization shall initiate a discharge plan for each participant who is voluntarily disenrolled. In each discharge plan, it shall state how it plans to do the following:
(1) Help the participant obtain necessary transitional care through referrals to other medicaid or medicare service providers.
(2) Provide the participant's medical records to new providers no later than thirty days after disenrollment.
(F) After the participant initiates a voluntary disenrollment, the participant shall do the following:
(1) Complete the mandate regarding the disenrollment form in paragraph (C)(3) of this rule.
(2) Continue to obtain necessary services from the PACE organization until the date of disenrollment.
(3) Remain liable for any premium or patient-liability costs incurred for services rendered by the PACE organization for all dates before the date of disenrollment.
Last updated April 15, 2024 at 11:31 AM
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