Rule 5160-36-02 | Program of all-inclusive care for the elderly (PACE) program administration.
(A) In accordance with section 173.50 of the Revised Code, the Ohio department of aging (ODA) shall serve as the designated state administering agency for PACE and shall adhere to and monitor the implementation of all applicable requirements for the program's administration as set forth in 42 C.F.R Part 460 as in effect on October 1, 2019.
(B) ODA shall:
(1) Facilitate the process in which prospective PACE organizations apply to the centers for medicare and medicaid services (CMS) for approval to provide PACE services;
(2) Enter into a PACE agreement with (CMS) and each PACE organization approved by CMS to provide PACE services to participants in Ohio who reside in the PACE organization's designated service area. The content and duration of that agreement shall conform to standards set forth in 42 C.F.R. Part 460 as in effect on October 1, 2019.
(3) Verify that PACE organizations providing PACE services have signed medicaid provider agreements as required by rule 5160-1-17 of the Administrative Code.
(4) Work with PACE organizations to assist individuals seeking enrollment in PACE.
(5) Manage PACE enrollment.
(6) Adopt rules including, but not limited to, participant eligibility, participant enrollment, participant voluntary disenrollment and participant involuntary disenrollment.
(7) Confer as necessary and appropriate with the Ohio department of medicaid (ODM) on matters including but not limited to:
(a) Participant eligibility;
(b) Participant enrollment and disenrollment, and program waiting list;
(c) Establishing the payment for PACE organizations operating in Ohio;
(d) Designating each PACE organization's service area;
(e) The enrollment and disenrollment of PACE organizations; and
(f) The termination of PACE agreements.
(C) ODM shall be responsible for the capitated payments made to PACE organizations for medicaid services rendered to PACE participants.
Supplemental Information