(1) You may choose to voluntarily end your enrollment in the PACE program without cause at any time. To do so, you must give the PACE provider written notice. If you give notice:
(a) Before the fifteenth of the month, the department will end your enrollment effective at the end of the month; or
(b) After the fifteenth, the department will end your enrollment effective until the end of the following month.
(2) Your enrollment may also end involuntarily if you:
(a) Move out of the designated service area or are out of the service area for more than thirty consecutive days, unless the PACE provider agrees to a longer absence due to extenuating circumstances;
(b) Engage in disruptive or threatening behavior such that the behavior jeopardizes your health or safety, or the safety of others;
(c) Fail to comply with your plan of care or the terms of the PACE enrollment agreement;
(d) Fail to pay or make arrangements to pay your part of the costs after the thirty-day grace period;
(e) Become financially ineligible for medicaid services, unless you choose to pay privately;
(f) Are enrolled with a provider that loses its license and/or contract; or
(g) No longer meet the nursing facility level of care requirement as defined in WAC 388-106-0205
(3) For any of the above reasons, the PACE provider must give you written notice, explaining that they are terminating benefits. If the provider gives you notice:
(a) Before the fifteenth of the month, then the department will end your enrollment at the end of the month; or
(b) After the fifteenth, then the department will end your enrollment at the end of the following month.
(4) Before the PACE provider can involuntarily end your enrollment in the PACE program, the department must review and approve it.
[Statutory Authority: RCW 74.08.090
, 74.09.520, 74.39A.010 and 74.39A.020. WSR 06-05-022, § 388-106-0715, filed 2/6/06, effective 3/9/06. Statutory Authority: RCW 74.08.090
, 74.09.520. WSR 05-11-082, § 388-106-0715, filed 5/17/05, effective 6/17/05.]