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

C 265 PACE Disenrollment

completion of an intensive assessment that includes aminimum of one home visit and one visit by the potential PACE enrollee to the PACE center.

C-265 PACE Disenrollment MS Manual 01/01/21 Participants may voluntarily disenroll from the PACE program at any time for any reason. Participants may be involuntarily disenrolled due to: 1. The participant’s failure to pay if he/she has a payment responsibility 2. The participant’s disruptive or threatening behavior 3. The participant moving out of the PACE service delivery area 4. The participant no longer meeting the nursing facility Level of Care requirement 5. The participant’s death 6. The PACE organization cannot provide the required services due to loss of licensure or contracts with outside providers 7. A PACE program agreement is not renewed The PACE Organization may appeal an adverse decision to the Division of Aging, Adult and Behavioral Health Services (DAABHS). If a timely appeal is received on or before the effective date of the action, the petitioner’s case will remain open and benefits will continue until the hearing decision. If the petitioner wishes not to continue benefits until the hearing decision, they must opt out.

C-266 PACE Provider Post-Enrollment Assessments MS Manual 07/01/20 Upon enrollment, it is required that each PACE provider have an interdisciplinary team in place that is responsible for the overall assessment of care needs and subsequent management, supervision and provision of care for PACE participants. The team’s membership consists of a primary care physician (PCP), registered nurse, social worker, physical therapist, occupational therapist, recreational therapist/activity coordinator, dietician, PACE center supervisor, home care coordinator, personal care attendant/aid, and a transportation staff/driver.