Ohio Administrative Code
Title 173 - Department of Aging
Chapter 173-50 - PACE Program
Section 173-50-05 - PACE: involuntary disenrollment
Universal Citation: OH Admin Code 173-50-05
Current through all regulations passed and filed through September 16, 2024
(A) A participant is subject to involuntary disenrollment from PACE for an reason outlined in 42 C.F.R. 460.164(b).
(B) Process to involuntarily disenroll a PACE participant:
(1)
If a PACE
organization requests permission to disenroll a participant under this rule, it
shall submit the request to ODA along with documentation reflecting grounds for
involuntary disenrollment and the PACE organization's efforts to remedy the
situation.
(2)
ODA shall approve or deny the request based upon the
requirements in paragraph (A) of this rule and notify the PACE organization of
the decision.
(3)
If ODA does not approve the request, the PACE
organization shall continue to provide necessary services to the
participant.
(4)
If ODA approves the request, the PACE organization is
subject to the involuntary disenrollment process in
42 C.F.R.
460.164,
460.166, and
460.172.
(5)
A participant's
involuntary disenrollment is effective on the first day of the next month that
begins thirty days after the day the PACE organization sends notice of the
disenrollment to the participant.
(6)
After ODA
approves an involuntary disenrollment, ODA sends the participant a notice of
denial and hearing rights under division 5101:6 of the Administrative
Code.
(a)
If the
participant requests a hearing within fifteen days after ODA approves the
involuntary disenrollment, ODA places the disenrollment on hold until a state
hearing has been conducted.
(b)
If the decision
of the state hearing is that ODA made a correct decision to disenroll, then ODA
enters the decision into the ODA- and ODM- approved eligibility
systems.
(c)
If the decision of the state hearing is that ODA made
an incorrect decision to disenroll, the participant remains enrolled in
PACE.
Replaces: 173-50-05
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