Regulation .06 Pace Participant Enrollment.
Regulation .06 Pace Participant Enrollment.LinkCopy Citation
A.
The Department shall enroll eligible persons who have chosen to enroll in the PACE provider.
B.
The PACE provider shall enter into an enrollment agreement with an eligible participant on the form approved by the Department.
C.
The PACE provider shall enroll eligible participants in the order in which they apply, and may not discriminate on the basis of health status in its enrollment, re-enrollment, or disenrollment procedures.
D.
Signature on Enrollment Forms.
(1)
Except as indicated under §D(2) of this regulation, a participant 55 years old or older shall sign and submit the enrollment form;
(2)
A legal guardian or legal representative shall sign enrollment forms for eligible persons determined to be incapacitated or incompetent to sign the form.
E.
Because the PACE provider is responsible for ensuring that participants whose primary language is not English understand the benefits and restrictions associated with enrollment in PACE, the PACE provider shall give to such a participant at the time of enrollment a:
(1)
Notice that translation services are available; or
(2)
List of primary care providers who speak foreign languages.
F.
Subject to verification of eligibility, enrollment shall be effective on the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement.
G.
An individual eligible for enrollment under Regulation .05 of this chapter, may enroll at any time during the term of the PACE Provider Agreement, unless:
(1)
Enrollment under the PACE Organization Provider Agreement has been suspended pursuant to Regulation .23 of this chapter; or
(2)
The PACE provider exceeds the enrollment limit established by the Department.
H.
The PACE provider shall:
(1)
Maintain a list of all individuals denied enrollment in the order in which they applied for enrollment; and
(2)
Promptly offer enrollment to denied individuals when permitted.
I.
The PACE provider shall provide to each PACE participant an identification card, clearly indicating the bearer is enrolled with the PACE provider.
J.
The PACE provider shall provide in writing and explain to a new participant, at a minimum, the following:
(1)
Notification of the PACE participant's right to terminate enrollment, the time frame required, and explanation of the required process; and
(2)
Information about the proper utilization of pharmacy services including the requirement to use one pharmacy within the PACE provider network to fill all prescriptions.