Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-36 - Program of All-Inclusive Care for the Elderly (PACE)
Section 5160-36-02 - Program of all-inclusive care for the elderly (PACE) administration
Universal Citation: OH Admin Code 5160-36-02
Current through all regulations passed and filed through September 16, 2024
(A) In accordance with section 173.50 of the Revised Code, the Ohio department of aging (ODA) shall serve as the designated state administering agency for PACE and shall adhere to and monitor the implementation of all applicable requirements for the program's administration as set forth in 42 C.F.R Part 460 as in effect on October 1, 2019.
(B) ODA shall:
(1) Facilitate the process in which
prospective PACE organizations apply to the centers for medicare and medicaid
services (CMS) for approval to provide PACE services;
(2) Enter into
a PACE
agreement with
(CMS)
and
each PACE organization approved by CMS to provide PACE services to participants
in Ohio who reside in the PACE organization's designated service area. The
content and duration of that agreement shall conform to standards
set
forth in 42 C.F.R. Part 460 as in effect on October 1,
2019.
(3)
Verify that PACE organizations providing PACE services have signed medicaid
provider agreements as required by rule
5160-1-17 of the Administrative
Code.
(4) Work with PACE
organizations to assist individuals seeking enrollment in
PACE.
(5) Manage PACE enrollment.
(6)
Adopt rules including, but not limited to, participant eligibility,
participant enrollment,
participant voluntary disenrollment
and participant involuntary
disenrollment.
(7) Confer as necessary and appropriate with the Ohio
department of medicaid (ODM) on matters including but not limited to:
(a)
Participant
eligibility;
(b)
Participant enrollment and
disenrollment, and program waiting
list ;
(c) Establishing the payment
for PACE organizations operating in Ohio;
(d) Designating each PACE organization's
service area;
(e) The enrollment
and disenrollment of PACE organizations;
and
(f) The
termination of PACE
agreements.
(C) ODM shall be responsible for the capitated payments made to PACE organizations for medicaid services rendered to PACE participants.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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