173-50-04 Voluntary disenrollment.

 

 

 

173-50-04                    PACE: Voluntary disenrollment.

 

 

 

(A)  A participant may voluntarily disenroll from PACE at any time without cause.

 

(B)  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 orally or in writing.

 

(2)   Once the PACE organization receives the participant's request, it shall provide the participant with a disenrollment form.

 

(3)   Once the participant receives the disenrollment form, he or she shall sign the form and return it to the PACE organization.

 

(4)    After the PACE organization receives the signed disenrollment form, it shall forward the form to ODA on the participant's behalf no later than one working day after receiving the form.

 

(5)    Once ODA receives a signed disenrollment form, it shall chose a date of disenrollment that occurs occurring no earlier than the date on which the signed disenrollement form was received by the PACE organization and no later than the first day of the month after the month during which the PACE organization forwards the disenrollment form to ODA.

 

(6)    After ODA chooses a date of disenrollment, it shall notify the participant in writing.

 

(C)  After a participant initiates a voluntary disenrollment, the PACE organization shall:

 

(1)   Complete the mandates regarding the disenrollment form in paragraphs (B)(2) and (B)(4) of this rule;

 

(2)   Continue to furnish provide necessary services to the participant until the date of disenrollment;

 

(3)   Create a discharge plan to help the participant obtain necessary transitional care through referrals to other medicaid or medicare service providers, preferably within the service area; and,

 

(4)     Provide  the  medical  records  of  the  participant  in  a  timely  manner  to  any

 

 

provider to whom a referral is made as part of the discharge plan.

(D)  After the participant initiates a voluntary disenrollment, he or she shall:

(1)   Complete the mandate regarding the disenrollment form in paragraph (B)(3) of this rule;

(2)    Continue to obtain necessary services from the PACE organization until the date of disenrollment; and,

(3)    Remain liable for any premium or patient-liability costs incurred for services rendered by the PACE organization for all dates before the date of disenrollment.

Effective:                                                             08/01/2016

Five Year Review (FYR) Dates:                         04/18/2016 and 08/01/2021

CERTIFIED ELECTRONICALLY

Certification

06/23/2016

Date

Promulgated Under:                           119.03

Statutory Authority:                           173.01, 173.02, 173.50

Rule Amplifies:                                  173.50, 173.55; 42 C.F.R. 460.152, 460.154, 460.156

(October, 2015 edition)

Prior Effective Dates:                         03/28/2009, 01/14/2010, 03/12/2011, 09/29/2011, 02/17/2013