5101:3-36-04 Program of all-inclusive care for the elderly (PACE) enrollment, disenrollment, and waiting lists.

(A) Individuals eligible and seeking to enroll in the PACE program shall enroll in the manner established in rule 173-50-03 of the Administrative Code unless paragraph (B) of this rule applies.

(B) If the number of eligible individuals seeking enrollment in the PACE program exceeds the number of slots allocated by the Ohio department of aging (ODA), ODA may establish and maintain a waiting list for PACE enrollment.

(C) Should a waiting list for PACE enrollment be maintained by ODA, ODA shall, on a semiannual basis, provide the Ohio department of job and family services (ODJFS) with the number of individuals on the waiting list for PACE services, the service area in which they reside, and the average length of time consumers on the waiting list shall wait before enrolling in PACE.

(D) A PACE participant may choose to voluntarily disenroll from the PACE program at any time without cause if the participant or the participant's authorized representative informs the PACE organization orally or in writing.

(1) Should a PACE participant choose to voluntarily disenroll from PACE, ODA shall, prior to the participant's disenrollment, verify that the voluntary disenrollment was initiated by the consumer or the consumer's authorized representative.

(2) The voluntary disenrollment of a PACE participant shall occur in the manner prescribed in rule 173-50-04 of the Administrative Code.

(E) A PACE organization may initiate the involuntary disenrollment of a PACE participant if any of the following applies:

(1) The PACE participant no longer meets the eligibility criteria for the PACE program contained in rule 173-50-02 of the Administrative Code.

(2) The PACE participant meets the criteria for involuntary disenrollment in paragraph (A) of rule 173-50-05 of the Administrative Code.

(3) The involuntary disenrollment of a PACE participant shall occur in the manner prescribed in rule 173-50-05 of the Administrative Code.

Effective: 03/28/2009
R.C. 119.032 review dates: 03/01/2014
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.02 , 5111.91 , 173.50