Your benefits from Elderhaus PACE can be stopped if you choose to give up your enrollment in the program. If you decide to give up these benefits, you have done it voluntarily (on your own). If you no longer meet the conditions of enrollment, you will give up the benefits involuntarily.
You must still use Elderhaus PACE services and pay the monthly charge, if there is any, until you are withdrawn from PACE services and enrolled in appropriate Medicare and/or Medicaid programs. If you are in the hospital on the date of your planned disenrollment, your Elderhaus PACE benefits will continue until your discharge from hospital and the next disenrollment period (normally the first of the month).
NOTE: You cannot disenroll from Elderhaus PACE by going to the Social Security office. You must tell Elderhaus PACE you want to leave the program.
Voluntarily Leaving Elderhaus PACE
If you want to cancel your benefits by leaving Elderhaus PACE, you should talk about it with a team member at the Elderhaus PACE Day Health Center. You may leave for any reason at any time. However, please let us know either verbally or in writing. If you tell us verbally of your wish to disenroll, you must sign a disenrollment form. Elderhaus PACE will disenroll you as soon as possible, but Elderhaus PACE needs time to coordinate your health care outside of Elderhaus PACE with community providers so that your health needs may continue to be met.
Involuntarily Leaving Elderhaus PACE
Elderhaus PACE can stop your benefits by giving you thirty (30) days’ notice in writing if:
- You move out of Elderhaus PACE service area for more than thirty (30) days, unless the absence is due to circumstances beyond your control (in which case you must have notified us in writing); or
- You or your caregiver consistently do not follow instructions for your individualized plan of care, and/or the terms of your enrollment agreement thereby threatening your health and safety; or
- Your or your caregivers behavior threatens the health and safety of you or others; or
- You do not pay or have not worked out some way to pay any money due Elderhaus PACE after the thirty (30) day grace period; or
- You no longer meet nursing facility level of care eligibility; or
- Elderhaus PACE loses the contract with Medicare and/or Medicaid and/or licenses which make it possible to provide health care services.
The effective date to all rights to benefits will stop at midnight of the last day of the month following the end of the thirty (30) day notice period. You must use Elderhaus PACE services until that date.
Whether your disenrollment is voluntary or involuntary, Elderhaus PACE will do its best to make sure you receive care for services in other Medicare and Medicaid programs for which you are eligible. We will work with the Medicare and Medicaid agencies by making your medical records available to your new care providers in a timely manner.
If you had additional health care coverage through a Medigap policy, you may be eligible to reapply for that policy when you disenroll from Elderhaus PACE. Elderhaus PACE will help you with this process.
You have the right to file an appeal of any Involuntary disenrollment.