D.C. Mun. Regs. tit. 29, r. 29-8803
The PACE organization shall have a written participant bill of rights designed to protect and promote the rights of each participant, which include, at minimum:
The PACE organization shall inform each participant and his or her authorized representative, if any, upon enrollment, in writing, of his or her rights and responsibilities, and all rules and regulations governing participation.
The PACE organization shall fully explain these rights to each participant and his or her authorized representative, if any, at the time of enrollment in a manner understood by the participant.
The PACE organization shall display the participant rights in accordance with the requirements set forth at 42 CFR § 460.116.
The PACE organization shall protect and provide for the exercise of participant rights and shall have established documented procedures to respond to and rectify a violation of a participant's rights, in accordance with 42 CFR § 460.118.
The PACE organization shall establish a written process to evaluate and resolve participant complaints expressing dissatisfaction with service delivery or the quality of care furnished, in accordance with the requirements set forth at 42 CFR § 460.120.
The PACE organization shall establish a written appeals process to address the PACE organization's noncoverage of, or nonpayment for, a service, including denials, reductions, or termination of services, in accordance with the requirements set forth at 42 CFR § 460.122.
The PACE organization shall inform a participant and his or her authorized representative, if any, in writing of his or her appeal rights under Medicare or Medicaid managed care, or if both are applicable, assist the participant in choosing which to pursue, and forward the appeal to the appropriate external entity, in accordance with 42 CFR § 460.124.
The PACE organization shall also provide a Medicaid beneficiary participant and his or her authorized representative, if any, with information regarding the right to appeal any decision referenced in § 8803.7 by filing a hearing request with the District of Columbia Office of Administrative Hearings.
D.C. Mun. Regs. tit. 29, r. 29-8803