Disenrollment Process for HealthChoice Participants to Enroll in Program of All-Inclusive Care for the Elderly

REQUIREMENTS: - Effective immediately: Billing team and patient service representatives must be trained on the new PACE disenrollment process and informed that Maryland HealthChoice participants ages 55-64 may transition to PACE organizations. - For patients inquiring about PACE enrollment: Direct them to contact the PACE organization directly; do not process manual MCO disenrollment requests. PACE organizations will manage the disenrollment process. - Update internal protocols to recognize that patients who have enrolled in PACE are no longer HealthChoice members and cannot bill to the MCO for services provided after MCO disenrollment effective date. - Document in billing system that PACE participants' coverage ends on the last day of the month in which their enrollment is approved; PACE coverage begins the first of the following month. - Do not process claims for services provided by PACE organizations before their MCO disenrollment is officially effective, as capitation payments will not be issued for pre-disenrollment care. - Contact mdh.healthchoiceprovider@maryland.gov for managed care questions or mdh.DHPS@maryland.gov for PACE-specific inquiries.