Page:United States Statutes at Large Volume 111 Part 1.djvu/566

 Ill STAT. 542 PUBLIC LAW 105-33—AUG. 5, 1997 "(2) CONDITION. — An individual is not a PACE program eligible individual (with respect to payment under this section) unless the individual's health status has been determined by the Secretary or the State administering agency, in accordance with regulations, to be comparable to the health status of individuals who have participated in the PACE demonstration waiver programs. Such determination sheill be based upon information on health status and related indicators (such as medical diagnoses and measures of activities of daily living, instrumental activities of daily living, and cognitive impairment) that are part of a uniform minimum data set collected by PACE providers on potential eligible individuals. "(3) ANNUAL ELIGIBILITY RECERTIFICATIONS. — "(A) IN GENERAL.— Subject to subparagraph (B), the determination described in subsection (a)(5)(B) for an individual shall be reevaluated at least annually. "(B) EXCEPTION.—The requirement of annual reevsiluation under subparagraph (A) may be waived during a period in accordance with regulations in those cases in which the 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 AISTY 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 disenroU without cause at any time. "(B) LIMITATIONS ON DISENROLLMENT. — "(i) IN GENERAL. —Regulations promulgated by the Secretary under this section and section 1894, and the PACE program agreement, shall provide that the PACE program may not disenroU 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 disenroU a PACE program eligible individual on the ground that the individual has engaged in noncompliant behavior if such behavior

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