Protecting Your Rights
As a Suncoast PACE participant, you have the right to fully participate in all decisions related to your health care. If you cannot do this or want someone who you trust to help, you can choose that person to act on your behalf. We ensure your right to choose by:
- Explaining all treatment options in a language that you understand
- Keeping you informed of your health status
- Helping you complete advance directive (living will) and/or dementia living will extension documents
- Ensuring our medical staff is available to address your concerns 24/7
- Providing written advance notice of any plan to move you to another treatment setting and the reason you are being moved
All of your health care services, including primary care and specialist services, must be received from the Suncoast PACE facility or an entity authorized by Suncoast PACE. Participants may be fully and personally liable for the costs of unauthorized or out-of-PACE agreement services.
When Emergencies Happen
As a Suncoast PACE participant, you are entitled to receive emergency medical services anywhere in the United States, whenever needed and without Suncoast PACE approval. These instances include when you think your health is in serious danger.
Rights and Responsibilities Upon Disenrollment from PACE
You will lose your benefits under Suncoast PACE if you choose (voluntarily) to disenroll from the program or if you no longer meet the conditions of enrollment (involuntarily). Both types of termination require 30 days written notice by either party. The effective date of termination of benefits is midnight of the last day of the month.
Suncoast PACE will continue to be responsible for your care and you will continue paying your usual monthly fee, if you have one, until the termination becomes effective. It usually takes 15 to 45 days to return to the community Medicaid system.
Voluntary Disenrollment: You may disenroll from the program at any time. Contact your Suncoast PACE social worker for additional information. Your social worker will request that you sign a disenrollment form. All disenrollments are effective on the first of the month.
Involuntary Disenrollment: Suncoast PACE wants to keep you as a participant and will work with you to resolve problems. If we are no longer able to provide appropriate care, Suncoast PACE can terminate your participation by giving you at least 30 days’ notice in writing. All involuntary disenrollments must be approved by the Agency for Health Care Administration and the Department of Elder Affairs.
Reasons disenrollment from Suncoast PACE may be required:
- Participant moves out of the Suncoast PACE service area or is out of the service area for more than 30 days, unless Suncoast PACE agrees to a longer absence due to extenuating circumstances.
- Suncoast PACE agreements with the Centers for Medicare and Medicaid (CMS), Agency for Health Care Administration (AHCA), and DOEA is not renewed or is terminated.
- Failure to pay or make satisfactory arrangements to pay any amount due Suncoast PACE after the 30-day grace period.
- Disruptive, unruly, abusive or uncooperative behaviors so that the care team is unable to safely provide services to you or other participants.
- Failure to comply with Plan of Care or the Enrollment Agreement.
- Suncoast PACE is unable to offer health care services due to loss of state licenses or contracts with outside providers.
- Participant no longer meets the State Nursing Facility Level of Care and is not deemed eligible for Suncoast PACE.
Involuntary disenrollment requires approval from the AHCA and DOEA. The effective date of termination of benefits is midnight of the last day of the covered month. Participants are required to use Suncoast PACE’s services until termination becomes effective.
Medicare beneficiaries may not enroll or disenroll through Social Security Administration. If enrolled in any other Medicare or Medicaid prepaid plan or optional benefit, including hospice, while a Suncoast PACE participant, this is considered a voluntary disenrollment from our program. Once enrolled in any of these plans, participants will lose all services and benefits provided by Suncoast PACE. Participants who have additional health care coverage through a Medigap policy, may be eligible to reapply for that policy when disenrolled from Suncoast PACE. Suncoast PACE will help with this process. Participants have the right to a fair hearing any time services are denied, reduced, or terminated. Suncoast PACE cannot take benefits away until the state makes its decision.
Returning to Suncoast PACE
You may return to Suncoast PACE after a voluntary disenrollment as long as eligibility requirements are met. If you leave involuntarily because of failure to pay monthly bill, you can reenroll by paying the bill. However, this payment must be made before the end of the last month eligible for Suncoast PACE services, or the application process will have to start again. If bill is paid on time, coverage will begin starting on the first day of the next month.
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