Rule 173-50-04 | PACE: voluntary disenrollment.
(A) A participant may voluntarily disenroll from PACE at any time without cause.
(B) The PACE organization shall ensure its employees or contractors do not engage in any practice that would reasonably be expected to have the effect of steering or encouraging disenrollment of participants due to a change in health status.
(C) Process for voluntary disenrollment:
(1) A participant who wishes to voluntarily disenroll from PACE shall initiate the voluntary disenrollment process by informing the PACE organization verbally, electronically, or in writing.
(2) Once the PACE organization receives the participant's request, the PACE organization shall notify ODA in writing.
(3) A participant's voluntary disenrollment is effective on the first day of the month after the date the PACE organization receives the participant's notice of voluntary disenrollment.
(4) After receiving a written notice of disenrollment from the PACE organization, ODA shall enter the disenrollment in the ODA- and ODM-approved eligibility systems.
(D) After a participant initiates a voluntary disenrollment, the PACE organization shall continue to provide PACE services as outlined in the participant's plan of care until the effective date of disenrollment.
(E) Before disenrollment, the PACE organization shall initiate a discharge plan for each participant who is voluntarily disenrolled. In each discharge plan, it shall state how it plans to do the following:
(1) Help the participant obtain necessary transitional care through referrals to other medicaid or medicare service providers.
(2) Provide the participant's medical records to new providers no later than thirty days after disenrollment.
(F) After the participant initiates a voluntary disenrollment, the participant remains liable for any premium or patient-liability costs incurred for services rendered by the PACE organization until the effective date of disenrollment.
Last updated July 1, 2024 at 4:24 PM
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