E. Enrollment Agreement Materials.
(1) The PACE provider shall distribute the
enrollment agreement within 14 days of the PACE participant's effective date of
coverage with the PACE Program.
(2)
At a minimum the information in the enrollment agreement shall contain the
following elements:
(a) Location or locations
and office hours of the PACE providers;
(b) Telephone number or numbers to call for
more information;
(c) Choice and
use of primary care providers and policies on changing primary care
providers;
(d) How to access urgent
care services and advice;
(e) How
and when to use emergency services including ambulance;
(f) Information on the grievance and appeals
process, including confidentiality and requesting an administrative
hearing;
(g) How to access
interpreter services including sign interpreters;
(h) PACE participant rights and
responsibilities;
(i) 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;
(j) A clear statement that plan of care
decisions are determined by the participant's interdisciplinary team;
(k) Information on the availability of social
services and assistance in placement in community-based housing and
facilities;
(l) Information on
advance directives and physician order for life sustaining treatment;
(m) How to obtain copies of the participant's
records;
(n) How to obtain
nonemergency ambulance services and other medical transportation to
appointments, as appropriate;
(o)
Explanation of covered and noncovered services;
(p) How to obtain prescriptions;
and
(q) Confidentiality
policy.
(3) 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.
(4) The provider shall
offer orientation to the PACE program to new participants in person within 30
days of enrollment.
