(a) To be eligible for participation in PACE, the applicant must:
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(1) meet categorical relationship to disability (reference
OAC 317:35-5-4);
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(3) be age 55 years or older;
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(4) live in a PACE service area;
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(5) be determined by the PACE Interdisciplinary team as able to be safely served in the community. If the PACE provider denies enrollment because the IDT determines that the applicant cannot be served safely in the community, the PACE provider must:
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(A) notify the applicant in writing of the reason for the denial;
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(B) refer the individual to alternative services as appropriate;
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(C) maintain supporting documentation for the denial and notify CMS and OHCA of the denial and make the supporting documentation available for review; and
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(D) advise the client orally and in writing of the grievance and appeals process.
(b) To be eligible for Medicaid capitated payments, the participant must:
(c) To obtain and maintain eligibility, the participant must agree to accept the PACE providers and its contractors as the participant's only service provider. The participant may be held financially liable for services received without prior authorization except for emergency medical care.