noncompliant behavior
(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 1396u–4 of this title , 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.
Source
42 USC § 1395eee(c)(5)
Scoping language
None identified, default scope is assumed to be the parent (part E) of this section.