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1.13.2 EOHHS Responsibilities

EOHHS is responsible for the eligibility and enrollment functions set forth in § 1.13.4 of this Part, establishing PACE provider standards, and oversight and monitoring of all aspects of the PACE program. 1.13.3 PACE Provider Responsibilities A. The PACE provider is responsible for: 1. Point of entry identification; 2. Submitting all necessary documentation for initial determinations and reevaluations of a level of need and referral to EOHHS for a determination of financial eligibility; 3. Verifying PACE enrollment prior to service delivery; 4. Verifying and collecting required beneficiary liability (cost-share amount); 5. Providing and coordinating all integrated services; 6. Reporting changes to the PACE-eligibility status of participants; and 7. Adhering to all PACE provider requirements as outlined in the PACE Program Agreement between EOHHS and CMS, and to all credentialing standards required by EOHHS including data submission. 1.13.4 PACE Participation Criteria A. To qualify as a Medicaid-eligible PACE participant, an individual must: 1. Be fifty-five (55) years of age or older; 2. Meet the criteria for a high or the highest need for a nursing facility level of care in accordance with Part 50-00-5 of this Title; and 3. Meet all other financial and non-financial requirements for Medicaid LTSS such as, but not limited to, citizenship, residency, resources, income, and transfer of assets. B. Medicaid-eligible PACE participants may be, but are not required to be, enrolled in Medicare. 1.13.5 PACE Disenrollment A. Reasons for PACE Disenrollment – Reasons for disenrollment from PACE include but are not limited to:

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Official source

1.13.2 EOHHS Responsibilities

EOHHS is responsible for the eligibility and enrollment functions set forth in § 1.13.4 of this Part, establishing PACE provider standards, and oversight and monitoring of all aspects of the PACE program. 1.13.3 PACE Provider Responsibilities A. The PACE provider is responsible for: 1. Point of entry identification; 2. Submitting all necessary documentation for initial determinations and reevaluations of a level of need and referral to EOHHS for a determination of financial eligibility; 3. Verifying PACE enrollment prior to service delivery; 4. Verifying and collecting required beneficiary liability (cost-share amount); 5. Providing and coordinating all integrated services; 6. Reporting changes to the PACE-eligibility status of participants; and 7. Adhering to all PACE provider requirements as outlined in the PACE Program Agreement between EOHHS and CMS, and to all credentialing standards required by EOHHS including data submission. 1.13.4 PACE Participation Criteria A. To qualify as a Medicaid-eligible PACE participant, an individual must: 1. Be fifty-five (55) years of age or older; 2. Meet the criteria for a high or the highest need for a nursing facility level of care in accordance with Part 50-00-5 of this Title; and 3. Meet all other financial and non-financial requirements for Medicaid LTSS such as, but not limited to, citizenship, residency, resources, income, and transfer of assets. B. Medicaid-eligible PACE participants may be, but are not required to be, enrolled in Medicare. 1.13.5 PACE Disenrollment A. Reasons for PACE Disenrollment – Reasons for disenrollment from PACE include but are not limited to: