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BEM 167 3 of 5 PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY (PACE) BPB 2023-013 7-1-2023

BRIDGES ELIGIBILITY MANUAL STATE OF MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES

Note: An ex parte review (see glossary) is required before Medicaid closures when there is an actual or anticipated change unless the change would result in closure due to ineligibility for all Medicaid. When possible, an ex parte review should begin at least 90 days before the anticipated change is expected to result in case closure. The review includes consideration of all MA categories; see BAM 115 and 220. PATIENT-PAY AMOUNT A patient-pay amount will be calculated if a PACE enrollee is admit- ted to a nursing facility or hospital. The PACE organization is responsible for collecting the patient-pay amount. Notice of the start, effective date, and any changes to the amount must be sent to the PACE organization. NOTICES PACE organizations have received federal and state approval for administering the program. Therefore, the following information may be shared without a signed release from the client: • A copy of the DHS-3503, Verification Checklist. • A copy of the DHS-4598, Medical Program Eligibility Notice, or the system equivalent. • A copy of the DHS-1606, MA Determination Notice. The original DHS-3503, DHS-4598, DHS-1606 must be sent to the client or the guardian, court or agency who is legally responsible for the client. PACE PROVIDERS CareResources 1471 Grace St. S.E. Grand Rapids, MI 49506 616-913-2006 or 1-800-610-6299

LifeCircles- PACE Muskegon 560 Seminole Rd. Muskegon, MI 49444 231-733-8686 or 1-888-204-8626

LifeCircles-PACE Holland 12330 James St.