PACE participant definition
Examples of PACE participant in a sentence
Electing enrollment in any other Medicare or Medicaid prepayment plan or optional benefit, including the hospice benefit, after enrolling as a PACE participant is considered a voluntary disenrollment from PACE.
No AllCare PACE participant will be involuntarily disenrolled without prior review and approval of the State of Oregon Department of Human Services.
When a dual-eligible PACE participant files a grievance, the QAGC will provide guidance regarding the differences between the Medicare and Medicaid grievance processes and suggest which process should be used.
AllCare PACE participant and caregiver satisfaction surveys shall be conducted no less than annually.
If a PACE participant is assessed at SPL 14 or higher at the annual reassessment, the local APD/AAA case manager, in conjunction with the PACE interdisciplinary team (IDT), will review the participant's previous assessments to evaluate the effect of disenrollment on the participant's health status, ADLs, and social functioning.
If a PACE participant loses Medicaid eligibility or long-term care eligibility, the APD/AAA case manager will notify the PACE organization social worker.
If a PACE participant is eligible for both Medicare and Medicaid or is Medicare-only (with a private-pay premium), then the participant will have the two respective appeal options available.
Electing enrollment in any other Medicare or Medicaid prepayment plan or optional benefit, including the hospice benefit, after enrolling as an AllCare PACE participant is considered a voluntary disenrollment from AllCare PACE.
Non-payment: On occasion, a PACE participant may fail to provide the pay-in required to maintain long-term care service eligibility.
It is importation to remember that electing enrollment in any other Medicare or Medi- caid prepayment or optional benefit, including Medicare Part D or hospice benefit, af- ter enrolling as a PACE participant is considered a voluntary disenrollment.