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MEDICAL SERVICES POLICY MANUAL,SECTION C C-200 Alternative Application Processes

C-261 PACE Assessment Process for Nursing Facility Residents, ARChoices, or Assisted Living Facility Participants MS Manual 07/01/20 42 CFR § 460 Nursing facility residents, ARChoices Waiver recipients, or Assisted Living Facility (ALF) participants who wish to apply for PACE will be referred to the DHS RN for coordination of a medical assessment.

C-262 Approval/Denial for PACE Applicants MS Manual 07/01/20 A participant’s enrollment in the PACE program is effective on the first day of the calendar month following the date the PACEorganization receives the signed enrollment agreement; but it may not be prior to the date of application at the County Office or prior to the date the medical assessment was completed by the DHS RN. lf financial or non-financial criteria are not met, the application will be denied. If the application is denied, the client has the right to appeal by filing for a Fair Hearing. Refer to the MS L-100 section.

C-263 Approvals for Waiver Recipients to PACE and PACE Participants to Waiver MS Manual 07/01/20 When a Waiver recipient is found to be medically and financially eligible for PACE, the Waiver case will close the day before the PACE eligibility is started as the participant’s enrollment in the PACE program is effective on the first day of the calendar month. Refer to MS C-262. C-264 PACE Enrollment MS Manual 07/01/20 Participant enrollment into the PACE Program is voluntary. The Division of Aging, Adult and Behavioral Health Services (DAABHS) must assess the potential enrollee and concur that the client meets the requirements for nursing facility care prior to enrollment. The DHS-RN must certify that an assessment has been completed. The PACE provider must explain to the potential enrollee that enrollment in PACE results in disenrollment in any other Medicare or Medicaid plan and that enrollment requires the C 261 PACE Assessment Process for Nursing Facility Residents, ARChoices, or Assisted Living Facility Participants