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Emergency Services), the beneficiary may be liable for the full cost of those services.

4. When an individual enrolls in PACE, they are ineligible for any other Medicare plans or any other Medicaid services, programs, or optional benefits, except for Medicaid for Qualified Medicare Beneficiaries (MQB). Refer to X below.

D. Medicaid Eligibility for PACE

1. The county must determine Medicaid eligibility for individuals requesting PACE services following the rules and regulations for Aged, Blind and Disabled Medicaid, including the need for a FL-2.

2. DHB makes a prospective capitated monthly payment to the PACE organization for each eligible Medicaid participant. The local agency must determine Medicaid eligibility for individuals requesting PACE services.

3. Because of the exclusively frail population served by PACE and the immediate need for PACE services, it is imperative that Medicaid applications and requests for PACE services be expedited. Eligibility must be entered by the second to the last workday of the month in order for the PACE capitated payment to begin the next calendar month. Failure to enter PACE evidence by the second to the last workday of the month will result in denied payments to the PACE organization. PACE organizations are aware that application processing times can be reduced dramatically by assisting the county in obtaining financial and other eligibility information. Communication between the local agency and the PACE organization is crucial to attain priority processing of Medicaid eligibility for PACE services.

II. PACE AND MEDICAID REFERRAL PROCEDURES

The DHB 5106, PACE/Medicaid Referral, is used for communication, notification, and documentation between Medicaid and the PACE organization. Page 1 is completed by the county and page 2 is completed by the PACE organization. Page 1 contains an authorization for release of information to Medicaid and page 2 includes an authorization for release of information to PACE. The authorizations for release of information must be signed by the applicant/beneficiary and is valid for one year. This authorization is limited to information listed on the DHB-5106, PACE/Medicaid Referral, which includes notification of application denial and/or termination of eligibility.

A. Medicaid Applicant/Beneficiary (A/B) Requests PACE Services

When an individual requests PACE enrollment information from the local agency, the individual should be referred to the PACE organization covering the service area where the individual resides. The caseworker should also complete page 1 of the DHB -5106, PACE/Medicaid Referral, and send to the PACE organization.