Title 42

Volume 4 CHAPTER IV SUBCHAP E

Subchapter E - Programs Of All-inclusive Care For The Elderly (pace)

42:4.0.1.3.16	PART 460	PART 460 - PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
42:4.0.1.3.16.1	SUBPART A	Subpart A - Basis, Scope, and Definitions
42:4.0.1.3.16.1.182.1	SECTION 460.2	460.2 Basis.
42:4.0.1.3.16.1.182.2	SECTION 460.3	460.3 Part D program requirements.
42:4.0.1.3.16.1.182.3	SECTION 460.4	460.4 Scope and purpose.
42:4.0.1.3.16.1.182.4	SECTION 460.6	460.6 Definitions.
42:4.0.1.3.16.2	SUBPART B	Subpart B - PACE Organization Application and Waiver Process
42:4.0.1.3.16.2.182.1	SECTION 460.10	460.10 Purpose.
42:4.0.1.3.16.2.182.2	SECTION 460.12	460.12 Application requirements.
42:4.0.1.3.16.2.182.3	SECTION 460.14	460.14 [Reserved]
42:4.0.1.3.16.2.182.4	SECTION 460.16	460.16 [Reserved]
42:4.0.1.3.16.2.182.5	SECTION 460.18	460.18 CMS evaluation of applications.
42:4.0.1.3.16.2.182.6	SECTION 460.20	460.20 Notice of CMS determination.
42:4.0.1.3.16.2.182.7	SECTION 460.24	460.24 Limit on number of PACE program agreements.
42:4.0.1.3.16.2.182.8	SECTION 460.26	460.26 Submission and evaluation of waiver requests.
42:4.0.1.3.16.2.182.9	SECTION 460.28	460.28 Notice of CMS determination on waiver requests.
42:4.0.1.3.16.3	SUBPART C	Subpart C - PACE Program Agreement
42:4.0.1.3.16.3.182.1	SECTION 460.30	460.30 Program agreement requirement.
42:4.0.1.3.16.3.182.2	SECTION 460.32	460.32 Content and terms of PACE program agreement.
42:4.0.1.3.16.3.182.3	SECTION 460.34	460.34 Duration of PACE program agreement.
42:4.0.1.3.16.4	SUBPART D	Subpart D - Sanctions, Enforcement Actions, and Termination
42:4.0.1.3.16.4.182.1	SECTION 460.40	460.40 Violations for which CMS may impose sanctions.
42:4.0.1.3.16.4.182.2	SECTION 460.42	460.42 Suspension of enrollment or payment by CMS.
42:4.0.1.3.16.4.182.3	SECTION 460.46	460.46 Civil money penalties.
42:4.0.1.3.16.4.182.4	SECTION 460.48	460.48 Additional actions by CMS or the State.
42:4.0.1.3.16.4.182.5	SECTION 460.50	460.50 Termination of PACE program agreement.
42:4.0.1.3.16.4.182.6	SECTION 460.52	460.52 Transitional care during termination.
42:4.0.1.3.16.4.182.7	SECTION 460.54	460.54 Termination procedures.
42:4.0.1.3.16.4.182.8	SECTION 460.56	460.56 xxx
42:4.0.1.3.16.5	SUBPART E	Subpart E - PACE Administrative Requirements
42:4.0.1.3.16.5.182.1	SECTION 460.60	460.60 PACE organizational structure.
42:4.0.1.3.16.5.182.2	SECTION 460.62	460.62 Governing body.
42:4.0.1.3.16.5.182.3	SECTION 460.63	460.63 Compliance oversight requirements.
42:4.0.1.3.16.5.182.4	SECTION 460.64	460.64 Personnel qualifications for staff with direct participant contact.
42:4.0.1.3.16.5.182.5	SECTION 460.66	460.66 Training.
42:4.0.1.3.16.5.182.6	SECTION 460.68	460.68 Program integrity.
42:4.0.1.3.16.5.182.7	SECTION 460.70	460.70 Contracted services.
42:4.0.1.3.16.5.182.8	SECTION 460.71	460.71 Oversight of direct participant care.
42:4.0.1.3.16.5.182.9	SECTION 460.72	460.72 Physical environment.
42:4.0.1.3.16.5.182.10	SECTION 460.74	460.74 Infection control.
42:4.0.1.3.16.5.182.11	SECTION 460.76	460.76 Transportation services.
42:4.0.1.3.16.5.182.12	SECTION 460.78	460.78 Dietary services.
42:4.0.1.3.16.5.182.13	SECTION 460.80	460.80 Fiscal soundness.
42:4.0.1.3.16.5.182.14	SECTION 460.82	460.82 Marketing.
42:4.0.1.3.16.5.182.15	SECTION 460.84	460.84 Emergency preparedness.
42:4.0.1.3.16.5.182.16	SECTION 460.86	460.86 Payment to individuals and entities excluded by the OIG or included on the preclusion list.
42:4.0.1.3.16.6	SUBPART F	Subpart F - PACE Services
42:4.0.1.3.16.6.182.1	SECTION 460.90	460.90 PACE benefits under Medicare and Medicaid.
42:4.0.1.3.16.6.182.2	SECTION 460.92	460.92 Required services.
42:4.0.1.3.16.6.182.3	SECTION 460.94	460.94 Required services for Medicare participants.
42:4.0.1.3.16.6.182.4	SECTION 460.96	460.96 Excluded services.
42:4.0.1.3.16.6.182.5	SECTION 460.98	460.98 Service delivery.
42:4.0.1.3.16.6.182.6	SECTION 460.100	460.100 Emergency care.
42:4.0.1.3.16.6.182.7	SECTION 460.102	460.102 Interdisciplinary team.
42:4.0.1.3.16.6.182.8	SECTION 460.104	460.104 Participant assessment.
42:4.0.1.3.16.6.182.9	SECTION 460.106	460.106 Plan of care.
42:4.0.1.3.16.7	SUBPART G	Subpart G - Participant Rights
42:4.0.1.3.16.7.182.1	SECTION 460.110	460.110 Bill of rights.
42:4.0.1.3.16.7.182.2	SECTION 460.112	460.112 Specific rights to which a participant is entitled.
42:4.0.1.3.16.7.182.3	SECTION 460.114	460.114 Restraints.
42:4.0.1.3.16.7.182.4	SECTION 460.116	460.116 Explanation of rights.
42:4.0.1.3.16.7.182.5	SECTION 460.118	460.118 Violation of rights.
42:4.0.1.3.16.7.182.6	SECTION 460.120	460.120 Grievance process.
42:4.0.1.3.16.7.182.7	SECTION 460.121	460.121 xxx
42:4.0.1.3.16.7.182.8	SECTION 460.122	460.122 PACE organization's appeals process.
42:4.0.1.3.16.7.182.9	SECTION 460.124	460.124 Additional appeal rights under Medicare or Medicaid.
42:4.0.1.3.16.8	SUBPART H	Subpart H - Quality Improvement
42:4.0.1.3.16.8.182.1	SECTION 460.130	460.130 General rule.
42:4.0.1.3.16.8.182.2	SECTION 460.132	460.132 Quality improvement plan.
42:4.0.1.3.16.8.182.3	SECTION 460.134	460.134 Minimum requirements for quality improvement program.
42:4.0.1.3.16.8.182.4	SECTION 460.136	460.136 Internal quality improvement activities.
42:4.0.1.3.16.8.182.5	SECTION 460.138	460.138 Committees with community input.
42:4.0.1.3.16.9	SUBPART I	Subpart I - Participant Enrollment and Disenrollment
42:4.0.1.3.16.9.182.1	SECTION 460.150	460.150 Eligibility to enroll in a PACE program.
42:4.0.1.3.16.9.182.2	SECTION 460.152	460.152 Enrollment process.
42:4.0.1.3.16.9.182.3	SECTION 460.154	460.154 Enrollment agreement.
42:4.0.1.3.16.9.182.4	SECTION 460.156	460.156 Other enrollment procedures.
42:4.0.1.3.16.9.182.5	SECTION 460.158	460.158 Effective date of enrollment.
42:4.0.1.3.16.9.182.6	SECTION 460.160	460.160 Continuation of enrollment.
42:4.0.1.3.16.9.182.7	SECTION 460.162	460.162 Voluntary disenrollment.
42:4.0.1.3.16.9.182.8	SECTION 460.164	460.164 Involuntary disenrollment.
42:4.0.1.3.16.9.182.9	SECTION 460.166	460.166 Disenrollment responsibilities.
42:4.0.1.3.16.9.182.10	SECTION 460.168	460.168 Reinstatement in other Medicare and Medicaid programs.
42:4.0.1.3.16.9.182.11	SECTION 460.170	460.170 Reinstatement in PACE.
42:4.0.1.3.16.9.182.12	SECTION 460.172	460.172 Documentation of disenrollment.
42:4.0.1.3.16.10	SUBPART J	Subpart J - Payment
42:4.0.1.3.16.10.182.1	SECTION 460.180	460.180 Medicare payment to PACE organizations.
42:4.0.1.3.16.10.182.2	SECTION 460.182	460.182 Medicaid payment.
42:4.0.1.3.16.10.182.3	SECTION 460.184	460.184 Post-eligibility treatment of income.
42:4.0.1.3.16.10.182.4	SECTION 460.186	460.186 PACE premiums.
42:4.0.1.3.16.11	SUBPART K	Subpart K - Federal/State Monitoring
42:4.0.1.3.16.11.182.1	SECTION 460.190	460.190 Monitoring during trial period.
42:4.0.1.3.16.11.182.2	SECTION 460.192	460.192 Ongoing monitoring after trial period.
42:4.0.1.3.16.11.182.3	SECTION 460.194	460.194 Corrective action.
42:4.0.1.3.16.11.182.4	SECTION 460.196	460.196 Disclosure of review results.
42:4.0.1.3.16.12	SUBPART L	Subpart L - Data Collection, Record Maintenance, and Reporting
42:4.0.1.3.16.12.182.1	SECTION 460.200	460.200 Maintenance of records and reporting of data.
42:4.0.1.3.16.12.182.2	SECTION 460.202	460.202 Participant health outcomes data.
42:4.0.1.3.16.12.182.3	SECTION 460.204	460.204 Financial recordkeeping and reporting requirements.
42:4.0.1.3.16.12.182.4	SECTION 460.208	460.208 Financial statements.
42:4.0.1.3.16.12.182.5	SECTION 460.210	460.210 Medical records.

---