1. A. Termination of a PACE participant's enrollment may be initiated by the:

   1. (1) PACE provider;
   2. (2) Department;
   3. (3) PACE participant; or
   4. (4) PACE participant’s legal guardian or legal representative.
2. B. All enrollment terminations require prior approval by the Department.

3. C. General Requirements for Processing Disenrollments.

   1. (1) The Department shall establish a timeline for the receipt of disenrollment forms as follows:

      1. (a) A PACE participant’s involuntary disenrollment occurs after the PACE provider meets the requirements set forth in 42 CFR §460.164 and is effective on the first day of the next month that begins 30 days after the day the PACE organization sends notice of the disenrollment to the PACE participant; or
      2. (b) A PACE participant’s voluntary disenrollment is effective on the first day of the month following the date the PACE organization receives the PACE participant’s notice of voluntary disenrollment.
   2. (2) Disenrollment requests shall be submitted to the Department by the PACE provider within 3 working days from completion, except if the PACE participant requests that the form be mailed to the PACE participant's home address for completion.
   3. (3) The PACE provider shall send the PACE participant a copy of the completed disenrollment forms, regardless of who initiated the disenrollment process.

4. D. Voluntary Disenrollment by PACE Participant.

   1. (1) In general, PACE participants may disenroll from the PACE provider at their discretion at any time without cause, by completing or having completed by a legal guardian or legal representative a disenrollment form provided by the Department.
   2. (2) The PACE provider shall act to facilitate disenrollment, including mailing disenrollment request forms to PACE participants desiring to disenroll but having difficulty accessing the PACE provider's office.
   3. (3) The PACE provider shall date-stamp PACE participants' disenrollment requests upon receipt.

5. E. Disenrollment Initiated by the PACE Provider.

   1. (1) The PACE provider shall have a written policy regarding termination of a PACE participant's enrollment by the PACE provider which shall address, at a minimum:

      1. (a) Under what conditions a PACE participant is to be disenrolled by the PACE provider; and
      2. (b) The time elements involved in processing terminations.
   2. (2) A disenrollment initiated by the PACE provider shall require prior approval by the Department.
   3. (3) A disenrollment may not occur because of an adverse change in the PACE participant's health status.
   4. (4) The PACE participant's complete medical and utilization history shall be provided by the PACE provider to the Department, upon request, in order to determine an appropriate disenrollment date.
   5. (5) The PACE provider shall notify the PACE participant within 14 days of when the disenrollment is approved, and the PACE participant may appeal the decision under the terms of COMAR 10.01.04.

   6. (6) Disenrollment may be requested by the PACE provider by providing to the Department acceptable documentation that the:

      1. (a) PACE participant's domicile was relocated outside the PACE provider's service area;
      2. (b) PACE participant is no longer eligible in accordance with Regulation .05 of this chapter;
      3. (c) PACE participant is discovered to be an individual for whom there existed legal documentation at the time of enrollment that the individual was mentally incompetent, but the PACE participant signed the enrollment form;
      4. (d) PACE participant commits fraudulent or illegal acts, such as permitting use of the PACE participant's medical identification card by others, altering a prescription, theft or other criminal acts committed in any provider's or PACE provider's premises;
      5. (e) PACE participant fails to complete and submit consents, releases, or assignments and other documents reasonably requested by the PACE provider in order to obtain or assure payment by Medicare, Medicaid, or other third party payers; or
      6. (f) PACE participant has died.
   7. (7) A PACE provider requesting disenrollment based on documentation under §E(6)(d) of this regulation shall report any illegal acts to law enforcement authorities or to the Medicaid Fraud Control Unit of the Department's Recipient Fraud Unit as appropriate.

   8. (8) If a request for disenrollment is approved, the PACE provider shall facilitate a PACE participant's enrollment into other programs by:

      1. (a) Making appropriate referrals; and
      2. (b) Ensuring clinical records are made available to new providers within 10 days of disenrollment.

6. F. Disenrollment by the Department. The Department shall disenroll a PACE participant if the:

   1. (1) PACE Organization Provider Agreement between the PACE provider and the Department is terminated;
   2. (2) PACE participant dies;
   3. (3) PACE participant becomes ineligible for enrollment in accordance with Regulation .05 of this chapter; or
   4. (4) PACE participant loses eligibility for Medical Assistance Program benefits or changes to a category of assistance not eligible for enrollment in PACE.

7. G. Effective Date of Termination.

   1. (1) The Department shall approve or disapprove requests for voluntary disenrollment within 5 working days of the date the request is received.
   2. (2) A disenrollment initiated by either the Department or the PACE provider because the participant died or became ineligible for enrollment for one of the other reasons specified in this regulation is effective the day after the event causing the ineligibility.
   3. (3) For disenrollments initiated by the Department, the Department shall provide the PACE provider with written notice.
   4. (4) A disenrollment resulting from the PACE participant's loss of Program eligibility shall be effective on the day following the PACE participant's last date of eligibility.

   5. (5) The Department may recover any capitation payments made on behalf of the PACE participant for periods following the effective date of the PACE participant's termination of enrollment or loss of eligibility, but not for a retroactive period greater than 3 months except in the case of:

      1. (a) The PACE participant's death; or
      2. (b) The PACE participant's relocation of domicile outside the PACE provider's service area.
   6. (6) The Department may determine a retroactive disenrollment date based on the conditions present when the disenrollment is requested or indicated.

Authority: Health-General Article, §2-104(b), 15-103, and 15-105, Annotated Code of Maryland

Effective date:

Regulations .01—.25 adopted as an emergency provision effective November 1, 2002 (29:25 Md. R. 1979); adopted permanently effective April 28, 2003 (30:8 Md. R. 540)

Regulation .01B amended effective October 14, 2013 (40:20 Md. R. 1652); August 19, 2024 (51:16 Md, R. 742); July 21, 2025 (52:14 Md. R. 713)

Regulation .03 amended effective January 29, 2018 (45:2 Md R. 68); July 21, 2025 (52:14 Md. R. 713)

Regulation .04 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .05A, B amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .06 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .07 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .09B amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .11E amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .12 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .15 amended effective August 19, 2024 (51:16 Md, R. 742); July 21, 2025 (52:14 Md. R. 713)

Regulation .16A amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .18F amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .20A amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .21 amended effective August 19, 2024 (51:16 Md, R. 742); July 21, 2025 (52:14 Md. R. 713)

Regulation .22 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .23 amended effective August 19, 2024 (51:16 Md, R. 742)

Regulation .23B amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .24C amended effective July 21, 2025 (52:14 Md. R. 713)