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Ohio Administrative Code (Last Updated: January 12, 2021) |
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5160 Medicaid |
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Chapter5160-36. Program of All-Inclusive Care for the Elderly (PACE) |
5160-36-01. Program of all-inclusive care for the elderly (PACE) definitions
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(A) "Authorized representative" has the same meaning as in rule 5160:1-1-01 of the Administrative Code.
(B) "Capitated payment" means the monthly payment paid to the program of all inclusive care for the elderly PACE organization by the Ohio department of medicaid ( ODM) for medical care and services provided to medicaid recipients enrolled in PACE.
(C) "Individual" is the applicant for or recipient of a medical assistance program such as medicaid.
(D) "Involuntary disenrollment" means the disenrollment of a participant from PACE at the request of the PACE organization or a county department of job and family services.
(E) "PACE" means the 'program of all-inclusive care for the elderly' as set forth in 42 C.F.R. Part 460 as in effect on October 1, 2019.
(F) "PACE center" means a facility operated by a PACE organization where primary care or other related services offered by PACE are provided to participants.
(G) "PACE organization" means an entity that has a medicaid provider agreement and also has in effect a PACE agreement with the centers for medicare and medicaid services (CMS) and the Ohio department of aging ( ODA).
(H) "PACE agreement" means an agreement between a PACE organization, CMS, and ODA.
(I) "Participant" means a person enrolled in and receiving services through PACE.
(J) "Private pay participant" means an individual who does not meet the medicaid eligibility criteria but chooses to participate in PACE and is responsible for payment of the PACE organization's private pay premium.
(K) "Service area" means the geographic area in which a PACE organization is approved by CMS and ODA to provide services to PACE participants.
(L) "State administering agency" means the state agency responsible for administering the PACE agreement. Pursuant to section 173.50 of the Revised Code ODA shall serve as the state administering agency for PACE in Ohio.
(M) "Voluntary disenrollment" means the disenrollment of a participant from PACE at the request of the participant or the participant's authorized representative.