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Glossary

PACE enrollment

How a person becomes a PACE participant: intake visits, a signed release so the organization can obtain medical and financial information, the state's level-of-care assessment, the organization's own safety assessment, and a signed enrollment agreement, effective the first day of the following month.

Also PACE intake, enrollment agreement, effective date of enrollment

42 CFR 460.152 calls intake “an intensive process during which PACE staff members make one or more visits to a potential participant’s place of residence and the potential participant makes one or more visits to the PACE center”. Four things must happen inside it:

  1. The person is told the terms: what PACE is, that the organization becomes the sole provider, the premiums and the conditions of enrollment and disenrollment.
  2. The person signs a release “to allow the PACE organization to obtain his or her medical and financial information and eligibility status for Medicare and Medicaid”. This is the moment the records work begins, and the authority for it.
  3. The state assesses level of care. The state administering agency must determine that the person needs the nursing facility level of care, Medicaid-eligible or not.
  4. The organization assesses safety. PACE staff must determine that the person “can be cared for appropriately in a community setting”. This is the one ground on which the organization itself may deny enrollment, and if it does it must notify the person in writing with the reason, refer them to alternatives, keep the documentation, and notify CMS and the state. The federal rule sets no deadline for that notice.

If the person is eligible and wants to enroll, they sign an enrollment agreement whose contents 460.154 lists from (a) to (t): identity, Medicare and Medicaid status, the services available, the premiums, the sole-provider acknowledgement, the authorization for data exchange with CMS and the state, the effective date, and the signature. Under 460.158 enrollment “is effective on the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement”, and from that date the interdisciplinary team has 30 calendar days to finish the plan of care.

The effective-date rule has a consequence every PACE enrollment director knows: an agreement signed on the 2nd and one signed on the 30th both take effect on the 1st of the following month. The intake calendar is monthly, and a person whose records or whose state assessment are not ready by the end of the month waits a full month more. From referral to enrollment puts every clock in one place.

Where it is defined

Vivlio for paceThe intake checklist, from twelve months of progress notes to the medication list, assembled before the team meets.

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