Disenrollment Responsibilities

(a) In disenrolling a participant, the PACE organization must take the following actions:

1. Use the most expedient process allowed under Medicare and Medicaid procedures, as set forth in the PACE program agreement.
2. Coordinate the disenrollment date between Medicare and Medicaid (for a participant who is eligible for both Medicare and Medicaid).
3. Give reasonable advance notice to the participant.

(b) Until the date enrollment is terminated, the following requirements must be met:

1. PACE participants must continue to use PACE organization services and remain liable for any premiums.
2. The PACE organization must continue to furnish all needed services.

(c) To facilitate a participant’s reinstatement in other Medicare and Medicaid programs after disenrollment, the PACE organization must do the following:

1. Make appropriate referrals and ensure medical records are made available to new providers within 30 days.
2. Work with CMS and the State administering agency to reinstate the participant in other Medicare and Medicaid programs for which the participant is eligible.

[64 FR 66279, Nov. 24, 1999, as amended at 84 FR 25676, June 3, 2019]