<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".12" citation="COMAR 10.09.44.12" title_num="10" subtitle_num="09" chapter_num="44" heading="Marketing and Information.">
  <paragraph num="A.">
    <text>The PACE Organization Provider Agreement shall specify the methods by which the PACE provider will assure the Department that its marketing plans, procedures, and materials are accurate and do not mislead, confuse, or defraud the Department or potential PACE participants.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The PACE provider's marketing plan and all marketing procedures and materials require approval by the Department before implementation and utilization.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The PACE provider may not participate in:</text>
    <paragraph num="(1)">
      <text>Activities described in 42 CFR §460.82(e); or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Face-to-face or telephone contact with a participant, or otherwise soliciting a participant who is not a PACE provider’s participant, unless authorized by the Department or initiated by the participant.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Subject to prior approval by the Department, a PACE provider may engage in marketing activities designed to make [recipient] participants aware of the PACE provider's availability as well as any special services offered. Addressee-blind informational mailings to an entire zip code may be used.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Enrollment Agreement and PACE Participant Enrollment Materials.</text>
    <paragraph num="(1)">
      <text>The PACE provider shall distribute the enrollment agreement within 14 days of the PACE participant's effective date of coverage with the PACE Program.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>At a minimum the information in the enrollment agreement shall contain the following PACE participant enrollment materials which shall remain with the PACE participant:</text>
      <paragraph num="(a)">
        <text>Location or locations and office hours of the PACE providers;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Telephone number or numbers to call for more information;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Choice and use of primary care providers and policies on changing primary care providers;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>How to access urgent care services and advice;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>How and when to use emergency services including ambulance;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Information on the grievance and appeals process, including confidentiality and requesting an administrative hearing;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>How to access interpreter services including sign interpreters;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>PACE participant rights and responsibilities;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>PACE participant's possible responsibility for charges including Medicare deductibles and coinsurances if the participant goes outside of the PACE Program for nonemergency care, or obtains noncovered services or services not authorized by the interdisciplinary team;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>A clear statement that plan of care decisions are determined by the participant's interdisciplinary team;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Information on the availability of social services and assistance in placement in community-based housing and facilities;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Information on advance directives and physician order for life sustaining treatment;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>How to obtain copies of the PACE participant's records;</text>
      </paragraph>
      <paragraph num="(n)">
        <text>How to obtain nonemergency ambulance services and other medical transportation to appointments, as appropriate;</text>
      </paragraph>
      <paragraph num="(o)">
        <text>Explanation of covered and noncovered services;</text>
      </paragraph>
      <paragraph num="(p)">
        <text>How to obtain prescriptions; and</text>
      </paragraph>
      <paragraph num="(q)">
        <text>Confidentiality policy.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The PACE provider shall review the enrollment agreement for accuracy at least yearly and update it with new or corrected information as needed to reflect the PACE provider's internal changes and regulatory changes. If changes impact the PACE participants' ability to use services or benefits, the PACE provider shall distribute the updated materials to all PACE participants after approval by the Department.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The provider shall offer orientation to the PACE program to new participants in person within 30 days of enrollment.</text>
    </paragraph>
  </paragraph>
</regulation>