Page:United States Statutes at Large Volume 111 Part 1.djvu/556

 Ill STAT. 532 PUBLIC LAW 105-33—AUG. 5, 1997 State administering agency determines that there is no reasonable expectation of improvement or significant change in an individual's condition during the period because of the severity of chronic condition, or degree of impairment of functional capacity of the individual involved. "(4) CONTINUATION OF ELIGIBILITY.— An individual who is a PACE program eligible individual may be deemed to continue to be such an individual notwithstanding a determination that the individual no longer meets the requirement of subsection (a)(5)(B) if, in accordance with regulations, in the absence of continued coverage under a PACE program the individual reasonably would be expected to meet such requirement within the succeeding 6-month period. "(5) ENROLLMENT; DISENROLLMENT. — " (A) VOLUNTARY DISENROLLMENT AT ANY TIME. —The enrollment and disenrollment of PACE program eligible individuals in a PACE program shall be pursuant to regulations and the PACE program agreement and shall permit enrollees to voluntarily disenroll without cause at any time. " (B) LIMITATIONS ON DISENROLLMENT. — "(i) IN GENERAL.— Regulations promulgated by the Secretary under this section and section 1934, and the PACE program agreement, shall provide that the PACE program may not disenroll a PACE program eligible individual except— " (I) for nonpayment of premiums (if applicable) on a timely basis; or "(II) for engaging in disruptive or threatening behavior, as defined in such regulations (developed in close consultation with State administering agencies). "(ii) No DISENROLLMENT FOR NONCOMPLIANT BEHAVIOR.— Except as allowed under regulations promulgated to carry out clause (i)(II), a PACE program may not disenroll a PACE program eligible individual on the ground that the individual has engaged in noncompliant behavior if such behavior is related to a mental or physical condition of the individual. For purposes of the preceding sentence, the term 'noncompliant behavior' includes repeated noncompliance with medical advice and repeated failure to appear for appointments. "(iii) TIMELY REVIEW OF PROPOSED NONVOLUNTARY DISENROLLMENT.— A proposed disenrollment, other than a voluntary disenrollment, shall be subject to timely review and final determination by the Secretary or by the State administering agency (as applicable), prior to the proposed disenrollment becoming effective. "(d) PAYMENTS TO PACE PROVIDERS ON A CAPITATED BASIS. — "(1) IN GENERAL. —In the case of a PACE provider with a PACE program agreement under this section, except as provided in this subsection or by regulations, the Secretary shall make prospective monthly payments of a capitation amount for each PACE program eligible individual enrolled under the agreement under this section in the same manner and from the same sources as payments are made to a Medicare+Choice

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