Edenbridge PACE participants may disenroll at any time, effective on the first day of the month following the date the PACE organization receives the participant’s notice of voluntary disenrollment.
(A) In disenrolling a participant, the Edenbridge PACE organization must take the following actions:
- Use the most expedient process allowed under Medicare and Medicaid procedures, as set forth in the Edenbridge PACE program agreement.
- Coordinate the disenrollment date between Medicare and Medicaid (for a participant who is eligible for both Medicare and Medicaid).
- Give reasonable advance notice to the participant.
(B) Until the date enrollment is terminated, the following requirements must be met:
- Edenbridge PACE participants must continue to use Edenbridge PACE organization services and remain liable for any premiums.
- The Edenbridge PACE organization must continue to furnish all needed services.
(C) To facilitate a participant’s reinstatement in other Medicare and Medicaid programs after disenrollment, the Edenbridge PACE organization must do the following:
- Make appropriate referrals and ensure medical records are made available to new providers within 30 days.
- Work with CMS and the State administering agency to reinstate the participant in other Medicare and Medicaid programs for which the participant is eligible.
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