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3. When a PACE beneficiary enters an adult care home (ACH), the PACE organization is responsible for the beneficiaries cost of care. Beneficiaries eligible for PACE and enrolled in a PACE program are not eligible for Special Assistance.

XI. AUTOMATED AND MANUAL NOTICES FOR PACE SERVICES

A. Automated and manual notices

1. Follow all notice requirements in MA-2420, Notices and Hearings Process, including the right to a fair hearing. The a/b has the right to request a hearing if they disagree with any decision regarding their benefits.

2. A/B notices should only be forwarded to the a/b and their representative. See MA- 2420, Notices and Hearings Process, for more information about representatives. If the PACE Organization is not an authorized representative, only the DHB-5106, PACE/Medicaid Referral, should be shared with the PACE Organization.

B. Approval Notice

Medicaid a/b - PACE Approved (application or ongoing with a change in situation):

1. Forward a copy of the DHB-5002, Important Notice About Your Medicaid or Special Assistance Approval, to the a/b, their authorized representative, and the PACE Organization.

2. A DHB-5016, Notification of Eligibility for Medicaid/Amount and Effective Date of Patient's Liability, should be generated and sent to the PACE organization as notification of the Patient Monthly Liability (PML).

C. Termination/Change

Medicaid Beneficiary – PACE Terminated

1. NC FAST automatically generates the DSS-8110 Notice of Modification, Termination, or Continuation. The caseworker should ensure that the notice is mailed to the beneficiary when PACE ends (Medicaid terminates, change to MQB, change to deductible, selecting a primary care provider – NC Medicaid Direct, change to non-PACE living arrangement, etc.), and

2. Forward a copy of the DSS-8110 Notice of Modification, Termination, or Continuation, to the beneficiary, their authorized representative, and the PACE Organization.

XII. PACE APPLICATION REPORT