NOTE: Change the consumer’s mailing and physical address to the facility’s address. See Contact Summary for information on updating an address.
Select Eligibility from Global Navigation. Select Customer Information from Local Navigation. Select LTC Data on the Task Navigation menu. The LTC Data List page displays.
Click the Edit button for the current PACE record.
Click the Edit button on the LTC Data Detail page in the Complete for Current PACE Enrollees block.
Complete the Current PACE Enrollees section:
Select the Yes from the Voluntary Disenrollment drop down
Enter the Effective Date field using the <mm/dd/yyyy> format or the calendar icon.
Enter a note in the Reason box stating admit Out of Network permanent stay
Click the Save and Return button. The LTC Data List page displays.
Complete the section below:
Click the Save and Return button when all necessary information is recorded. The LTC Data List page displays.
Select Run EDBC from Task Navigation to run EDBC for the appropriate month, If the admittance to the out of network facility was on the first of the month, use the first day of the month of admittance. If the admittance was after the first day of the month, use the first day of the month after admittance.
The Run EDBC page displays. See Running EDBC for detailed steps.
Example: If the admit date to the permanent stay is 02/18/2021 PACE will continue till 02/28/2021 and NF stay will begin 03/01/2021.
If the admit date to the permanent stay is 02/01/2021 PACE will end 01/31/2021 and NF will begin 02/01/2021.
Select the Benefit Month the permanent stay begins from the drop-down menu then click the Select button.
Select the program using the check box. If the month the permanent stay begins is not the come-up month, select Yes for a Timely Notice Exception and a Reason of LTC Late Change then click the Run EDBC button.
Click the Medical hyperlink with a Run Status of Not Accepted on the EDBC List page. The Medical EDBC Summary page displays.
Click the Eligible Budgets hyperlink to check that the LTC Details have accurate start and end dates. If the information is incorrect the user needs to correct the LTC Data Detail page(s).
Click the Close button to close the window. The Medical EDBC Summary page displays.
Click the Accept button if the EDBC Result is correct. The EDBC List page displays.
Click the Save and Continue button.
Run EDBC through the come-up month to high date the new eligibility. See Running EDBC for detailed steps. For months prior to the come-up month, select Yes for a Timely Notice Exception and a Reason of LTC Late Change.
Send Notices as appropriate. See Manual NOA Generation and Generating a Form for an Institutional Care Facility, ES-3166 Notification of Pace for detailed steps on sending notifications.
Select Journal from Utility Navigation. Record a Journal entry of the actions taken on the case. See Journal for more information about journaling functionality.