Enter the following information based on the ES-3166.
1. Complete the Pace Enrollment Information Section.
1. Under PACE Provider, click the Retrieve Information button. The Select Provider Resource page displays.
2. Enter the PACE Provider ID in the ID field. Use the following ID numbers when selecting a provider:
|
Provider |
ID Numbers |
|
MIDLAND CARE CONNECTION |
1011885 |
|
VIA CHRISTI HOPE (HEALTHCARE OUTREACH) |
1066095 |
|
BLUESTEM PACE |
1260029 |
3. Click the Search button.
4. Select the radio button next to the appropriate Provider and click the Select button.
5. Enter the following fields as shown on the ES-3166. Leave these blank if the information was not provided.
1. Anticipated Enrollment Date
2. Financial App Sent
3. Medicaid Referral
4. Service Information
2. Complete the Complete for New Pace Applicants section for those that apply. Leave these blank if the information was not provided.
1. Enrollment Accepted
2. Date of PACE assignment
3. Enrollment Denied by Customer and Reason
4. PACE Team Denied Enrollment and Reason
3. Complete the Complete for Current PACE Enrollees section if applicable.
1. If the consumer is currently or has previously been in a temporary stay while on PACE, enter the following fields.
1. Select Yes from the Temporary drop-down menu.
2. Enter or select the Admit Date.
3. Enter or select the Discharge Date. If it is a current stay, the discharge date is left blank and filled in once the consumer is discharged.
4. Enter the Facility Name.
NOTE: KEES will only hold information for one temporary stay so only the current or most recent temporary stay during PACE is recorded. Additional stays are documented in the Journal.
2. If the consumer is currently or has previously been in a long term or permanent stay at a PACE facility while remaining on PACE, enter the following information.
1. Select Yes from the Permanent drop-down menu.
2. Enter or select the Admit Date.
3. Enter or select the Discharge Date. If it is a current stay, the discharge date is left blank and filled in once the consumer is discharged.
4. Enter the Facility Name.
NOTE: KEES will only hold information for one long term or permanent stay so only the current or most recent long term or permanent stay during PACE is recorded. Additional stays are documented in the Journal.
3. Fill out the Disenrollment Information if the consumer has been disenrolled. This will usually be done as an update to an existing record. If the consumer is actively enrolled, leave this section blank.
1. For Voluntary Disenrollment, enter the following information otherwise leave blank.
1. Select Yes in the Voluntary Disenrollment drop down menu.
2. Enter the Effective Date for disenrollment.
3. Enter a short description for the Reason of disenrollment.
2. For Involuntary Disenrollment, enter the following information otherwise leave blank.
1. Select Yes in the Involuntary Disenrollment drop down menu.
2. Enter the Effective Date for disenrollment.
3. Select Yes in the State Approved drop down field.
3. For disenrollment due to death, the following fields may be entered.
1. Select Yes in the Death drop down menu.
2. Enter the Date of Death.
4. If allocating income, click the Add button to complete the Dependents of LTC/Applicant/Member or Dependents of Spouse block. See Income Allocation for more information.
5. If the consumer is in a PACE nursing facility for a long term or permanent stay, enter the Care Screening information.
1. Select Yes or No for the Care Screening Met drop down menu.
2. Enter or select the date the Screening was completed.
NOTE: If the consumer is exempt from a CARE screening, enter yes and the date the consumer became exempt from the screening requirement. Record this information in the Journal.