Ohio Admin. Code 5160-36-02 - Program of all-inclusive care for the elderly (PACE) administration

(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 the PACE program PACE and shall adhere to and monitor the implementation of all applicable requirements for the program's administration as contained set forth in 42 C.F.R Part 460 as in effect on October 1, 2013 2019.

(B) In this capacity 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 an agreement called the a PACE program agreement with (CMS) 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 contained set forth in 42 C.F.R. Part 460 as in effect on October 1, 2013. 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 the PACE. program.

(5) Manage PACE enrollment.

(6) Allocate and as appropriate reallocate slots to PACE organizations for use by individuals who are enrolled in the Ohio medicaid program. The allocation and reallocation of slots does not apply to medicare only or private pay patients.

(7) (6) Adopt rules including, but not limited to, PACE participant eligibility, PACE participant enrollment, PACE participant voluntary disenrollment and PACE participant involuntary disenrollment.

(8) (7) Confer as necessary and appropriate with the Ohio department of medicaid (ODM) on matters including but not limited to:

(a) PACE participant Participant eligibility;

(b) PACE participant Participant enrollment and , disenrollment, and PACE program waiting list trends;

(c) Establishing the payment rates of reimbursement for PACE organizations operating in Ohio;

(d) Designating each PACE organization's service area;

(e) The enrollment and disenrollment of PACE organizations; as providers of services through the PACE program; and

(f) The termination of PACE program agreements.

(C) ODM shall be responsible for the capitated payments made to PACE organizations for medicaid services rendered to PACE program participants.

Notes

Ohio Admin. Code 5160-36-02

Effective: 1/1/2020
Five Year Review (FYR) Dates: 10/15/2019 and 01/01/2025
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.35; 173.50
Prior Effective Dates: 03/28/2009, 07/01/2011 (Emer.), 09/29/2011, 01/01/2015