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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) |
5160-36-04. Program of all-inclusive care for the elderly (PACE): enrollment and disenrollment
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(A) Individuals eligible and seeking to enroll in PACE shall enroll in the manner established in rule 173-50-03 of the Administrative Code unless paragraph (B) of this rule applies.
(B) A participant may choose to voluntarily disenroll from PACE at any time without cause if the participant or the participant's authorized representative informs the PACE organization orally or in writing.
(1) Should a participant choose to voluntarily disenroll from PACE, ODA shall, prior to the participant's disenrollment, verify that the voluntary disenrollment was initiated by the individual or the individual's authorized representative.
(2) The voluntary disenrollment of a participant shall occur in the manner prescribed in rule 173-50-04 of the Administrative Code.
(C) A PACE organization may not initiate the involuntary disenrollment of a participant if any of the following applies:
(1) The participant no longer meets the PACE requirements set forth in rule 173-50-02 of the Administrative Code.
(2) The participant meets the criteria for involuntary disenrollment set forth in rule 173-50-05 of the Administrative Code.
(3) The involuntary disenrollment of a PACE participant shall occur in the manner prescribed in rule 173-50-05 of the Administrative Code.
(D) Once enrolled in PACE, an individual will not be disenrolled unless the individual requests disenrollment pursuant to paragraph (B) of this rule, moves out of state, or expires.