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Chapter: 1400 Technical Requirements Program: MSSI, SFP 51

1. at time of placement, 2. at each eligibility review (certification within 3 months may be considered "current"), 3. when the individual moves from one home/facility to another, or 4. when the individual is no longer appropriate for alternate care. 1440.1310 Appropriate Placement for PACE (MSSI) Individuals seeking alternatives to nursing home placement who live in participating areas are considered for placement in the Program for All-Inclusive Care for the Elderly (PACE) Program. The following criteria must be met for an individual to be considered appropriately placed for PACE.

1. be determined to meet NEED for PACE services as evidenced by receipt of DOEA CARE form 603 in case record (as determined by CARES, and 2. elect the PACE provider as his/her sole source of Medicare and/or Medicaid service delivery.

Note: Although PACE enrollees will initially enter into the program while living at home, once enrolled and determined eligible, a participant may move to an ALF or a nursing care facility without disenrolling from PACE.

A PACE participant cannot elect Hospice while simultaneously receiving PACE services. 1440.1400 REQUIREMENT TO FILE FOR OTHER BENEFITS (MSSI, SFP) Individuals must apply for and diligently pursue to conclusion an application for all other benefits for which they may be eligible as a condition of eligibility. Individuals who apply for SFP must apply for SSI as a condition of eligibility and are required to apply for all increased benefits for which they might qualify. Need cannot be established nor eligibility determined upon failure to do so. Benefits that must be applied for include, but are not limited to:

1. Pensions from local, state, or federal government, 2. Retirement benefits, 3. Social Security benefits, 4. Veterans' benefits, 5. UC benefits, 6. Military benefits, 7. Railroad retirement benefits, 8. Workers' Compensation benefits, and 9. Medicare Part A, Part B and Part D.

Individuals applying for Medicaid on the basis of age (65 or older) or disability must apply for Medicare if the state will pay the Medicare premium, deductible or co-insurance. If the individual is not eligible for a Medicare Savings Program (MSP), there is no requirement to apply for Medicare.

The Medicare Enrollment Data Base (EDB) file received from the Center for Medicare and Medicaid Services (CMS) contains information on individuals receiving both Medicaid and Medicare. The information from the EDB file is used to automatically enroll individuals in Medicare.

The application for Social Security benefits based on age or disability is presumed to be an application for Medicare.