Section 5160-36-03 - Medicaid funded program of all-inclusive care for the elderly (PACE) eligibility(A) To be eligible and maintain eligibility for PACE, an individual will meet the requirements for PACE participant eligibility set forth in rule 173-50-02 of the Administrative Code and will have been determined to be eligible for medicaid in accordance with Chapters 5160:1-3 to 5160:1-6 of the Administrative Code.(B) If a PACE participant who is also enrolled in medicaid has a continuous period of institutionalization as defined in rule 5160:1-6-01.1 of the Administrative Code, that individual's patient liability amount is to be calculated by the county department of job and family services as directed in rule 5160:1-6-07.1 of the Administrative Code.(C) Individuals who fail to meet the eligibility requirements in paragraph (A) of this rule will not be enrolled as a medicaid participant in PACE.(1) Once enrolled, participants who no longer meet the eligibility requirements in paragraph (A) of this rule will be involuntarily disenrolled from the medicaid-funded component of PACE pursuant to rule 173-50-05 of the Administrative Code.(2) An individual who no longer meets medicaid eligibility requirements in paragraph (A) of this rule may continue non-medicaid funded enrollment in PACE as defined within rule 173-50-02 of the Administrative Code.(D) PACE eligibility and enrollment for persons who are either medicaid enrollees or non-medicaid enrollees are described in section173.50 of the Revised Code. Replaces: 5160-36-03, 5160-36-04
Ohio Admin. Code 5160-36-03
Effective: 11/5/2023
Five Year Review (FYR) Dates: 11/05/2028
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.35, 173.50
Prior Effective Dates: 03/28/2009, 01/01/2015, 01/01/2020, 06/12/2020 (Emer.), 10/17/2020