Rule 5160-36-04 | Program of all-inclusive care for the elderly (PACE): enrollment and disenrollment.
(A) Individuals eligible and seeking to enroll in PACE shall enroll in the manner established in rule 173-50-03 of the Administrative Code unless paragraph (B) of this rule applies.
(B) A participant may choose to voluntarily disenroll from PACE 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 participant choose to voluntarily disenroll from PACE, ODA shall, prior to the participant's disenrollment, verify that the voluntary disenrollment was initiated by the individual or the individual's authorized representative.
(2) The voluntary disenrollment of a participant shall occur in the manner prescribed in rule 173-50-04 of the Administrative Code.
(C) Subject to paragraph (D) of this rule, a PACE organization may initiate the involuntary disenrollment of a participant if either of the conditions set forth in paragraph (C)(1) or (C)(2) of this rule are met.
(1) The participant no longer meets the PACE requirements set forth in rule 173-50-02 of the Administrative Code.
(2) The participant meets the criteria for involuntary disenrollment set forth in 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.
(D) Once enrolled in PACE, a participant will not be disenrolled if disenrollment results in the loss of medicaid eligibility, unless the participant requests disenrollment pursuant to paragraph (B) of this rule, moves out of state, or dies.
Last updated October 1, 2021 at 8:45 AM