Sec. 10.09.44.12. Marketing and Information

A. The PACE provider agreement shall specify the methods by which the PACE provider will assure the Department that its marketing plans, procedures, and materials are accurate and do not mislead, confuse, or defraud the Department or potential participants.

B. The PACE provider's marketing plan and all marketing procedures and materials require approval by the Department before implementation and utilization.

C. The PACE provider may not participate in:

(1) Activities described in 42 CFR §460.82(e); or

(2) Face-to-face or telephone contact with a recipient, or otherwise soliciting a recipient who is not a participant of the PACE provider, unless authorized by the Department or initiated by the recipient.

D. Subject to prior approval by the Department, a PACE provider may engage in marketing activities designed to make recipients aware of the PACE provider's availability as well as any special services offered. Addressee-blind informational mailings to an entire zip code may be used.

E. Enrollment Agreement Materials.

(1) The PACE provider shall distribute the enrollment agreement within 14 days of the PACE participant's effective date of coverage with the PACE Program.

(2) At a minimum the information in the enrollment agreement shall contain the following elements:

(a) Location or locations and office hours of the PACE providers;

(b) Telephone number or numbers to call for more information;

(c) Choice and use of primary care providers and policies on changing primary care providers;

(d) How to access urgent care services and advice;

(e) How and when to use emergency services including ambulance;

(f) Information on the grievance and appeals process, including confidentiality and requesting an administrative hearing;

(g) How to access interpreter services including sign interpreters;

(h) PACE participant rights and responsibilities;

(i) PACE participant's possible responsibility for charges including Medicare deductibles and coinsurances if the participant goes outside of the PACE Program for nonemergency care, or obtains noncovered services or services not authorized by the interdisciplinary team;

(j) A clear statement that plan of care decisions are determined by the participant's interdisciplinary team;

(k) Information on the availability of social services and assistance in placement in community-based housing and facilities;

(l) Information on advance directives and physician order for life sustaining treatment;

(m) How to obtain copies of the participant's records;

(n) How to obtain nonemergency ambulance services and other medical transportation to appointments, as appropriate;

(o) Explanation of covered and noncovered services;

(p) How to obtain prescriptions; and

(q) Confidentiality policy.

(3) The PACE provider shall review the enrollment agreement for accuracy at least yearly and update it with new or corrected information as needed to reflect the PACE provider's internal changes and regulatory changes. If changes impact the PACE participants' ability to use services or benefits, the PACE provider shall distribute the updated materials to all PACE participants after approval by the Department.

(4) The provider shall offer orientation to the PACE program to new participants in person within 30 days of enrollment.