Amendment No. am_136_2607

H. B. No. 750

As Introduced

__________________________ moved to amend as follows:

In line 1 of the title, delete "Regarding" and insert "To amend section 173.503 and to repeal section 173.502 of the Revised Code regarding"; after "expansion" insert "and timely enrollment"

After line 2, insert:

"Section 1. That section 173.503 of the Revised Code be amended to read as follows:

Sec. 173.503. The department of aging shall seek to implement a presumptive eligibility component to the PACE program, under which applicants for PACE may receive services under the program during a temporary period, to begin immediately upon application and a finding of presumptive eligibility, while a PACE organization conducts a full eligibility determination on behalf of the individual. If the individual is determined to be ineligible for PACE, the PACE organization that found the individual presumptively eligible shall be responsible for the costs of PACE services provided to the individual during the presumptive eligibility period.A PACE organization may enroll an individual in PACE on the first day of the month following the date the individual applied for PACE and begin providing PACE services to the individual before the individual's medicaid application has been approved, if the department of aging has determined that the individual meets all other PACE eligibility requirements. If the individual is found to be medicaid eligible, the department of medicaid shall reimburse the PACE organization for PACE services provided to the individual by the organization, beginning on the date the individual was enrolled in PACE under this section. If the individual is determined to be ineligible for medicaid, the PACE organization shall assume financial responsibility for the length of the individual's enrollment in PACE. The PACE organization may request the individual pay the private pay rate for PACE services. If the participant chooses not to pay the private pay rate, the PACE organization may follow the department of aging's involuntary disenrollment requirements to disenroll the individual.

Section 2. That existing section 173.503 of the Revised Code is hereby repealed.

Section 3. That section 173.502 of the Revised Code is hereby repealed."

In line 3, delete "1" and insert "4"

The motion was __________ agreed to.

SYNOPSIS

PACE timely enrollment

R.C. 173.503; R.C. 173.502 (repealed)

Repeals current law requiring a PACE organization, if an applicant is provided PACE services under presumptive eligibility and later determined to be ineligible for PACE, to be responsible for the costs of the PACE services provided to the individual during the presumptive eligibility period.

Permits a PACE organization to enroll an applicant in PACE on the first day of the month following the individual's application while the individual's Medicaid application is being processed, if ODA determines that the individual meets all other PACE eligibility requirements.

If the individual is determined to be Medicaid eligible, requires the Ohio Department of Medicaid to reimburse the PACE organization for PACE services provided to the individual during that presumptive eligibility period.

Requires, if the individual is determined ineligible for Medicaid, the PACE organization to assume financial responsibility for the length of the individual's PACE enrollment.

Allows the PACE organization to request that the ineligible individual pay the private pay rate for PACE services and allows the PACE organization, if the individual declines to pay, to follow ODA's involuntary disenrollment procedures.