Long Term Care (LTC): PACE Procedures – Disenrolling from PACE

The following instructions outline the procedure for Disenrolling for PACE.

Disenrolling from PACE can only be done effective the 1st of the following month and prior to last day of the month.

  1. PACE will notify worker in writing of disenrollment.
  2. If the client is only eligible for benefits by the waived income & resource guidelines of ADvantage, close medical benefits effective the first of the following month. If this is an involuntary disenrollment, we must give the client a 10 day notice. Otherwise, benefits are closed effective the last day of the month. No further action is required.
  3. If the client remains eligible for ABD benefits, close the case (for client’s request/non-cooperation) so the PACE certification will end effective the first of the following month. Refresh the case, add the client to benefits on HH tab, CERTIFY the case effective the 1st of the month using the notice from PACE as the application date and change the categorical relationship to the appropriate code. Notify Lisa Gallaway to push PACE closure to OHCA.
  4. If the client remains eligible for ABD benefits AND had open ADvantage prior to enrollment, close medical benefits effective the first of the following month, refresh the case, add client to benefits on HH tab, CERTIFY the case effective the 1st of the month using the date of notice from PACE as the new application date and change the categorical relationship to the appropriate code. Notify Lisa Gallaway to push PACE closure to OHCA.
    1. If ADvantage has been closed over 90 days, a new Harmony UCAT must be done and authorization lines placed on EKL for ADV & SPPC. A new level of care determination is required.
    2. If ADvantage has been closed less than 90 days, a new Harmony UCAT must be done for ADvantage only an EKL line for ADV placed in “F” status. No level of care determination is required. Notify the area nurse of the reopen.
  5. Handle the transfer of the case according to your county office procedure.
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