Ohio Admin. Code 5160-36-05 - Program of all-inclusive care for the elderly (PACE): care coordination

(A) Each PACE organization shall establish and maintain at each PACE center an interdisciplinary team to assess the care and service needs of PACE participants. The composition, qualifications, and activities of the interdisciplinary team shall be consistent with 42 C.F.R. Part 460 as in effect on October 1, 2013 2019.

(B) The interdisciplinary team shall conduct a comprehensive assessment and develop a plan of care for each PACE participant.

(1) The plan of care developed for each PACE participant shall specify which services are needed to meet the participant's medical, physical, emotional, and social needs as identified in the comprehensive assessment, and will identify measurable outcomes to be achieved for the PACE participant.

(2) The interdisciplinary team shall implement, coordinate, and monitor the PACE participant's plan of care and modify the plan of care as appropriate.

(3) The interdisciplinary team shall at least semiannually, or more often if the participant's condition dictates or if requested by the participant or the participant's authorized representative, reassess each PACE participant and make changes as necessary to the plan of care.

(4) The PACE interdisciplinary team shall collaborate with the participant in the development of the participant's plan of care as well as with changes made to the plan of care.

(C) (B) PACE organizations shall ensure that all PACE participants have access to all medically necessary services including, but not limited to, services covered by Ohio's medicaid program, in addition to those prescribed in 42 C.F.R. Part 460.92 as in effect on October 1, 2013 2019 to 42 C.F.R. Part 460.96 as in effect on October 1, 2013 2019.

(1) Services provided shall be sufficient in their amount, duration and scope to meet the participant's medical, physical, emotional, and social needs as identified in the comprehensive assessment to achieve the measurable outcomes identified in the participant's plan of care.

(2) Services provided shall be reflected in the participant's plan of care unless the services are an emergency service.

Notes

Ohio Admin. Code 5160-36-05

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, 01/01/2015