Part 460 - Programs of All-Inclusive Care for the Elderly (Pace)


Subpart A - Basis, Scope, and Definitions
§ 460.2 - Basis.
§ 460.3 - xxx
§ 460.4 - Scope and purpose.
§ 460.6 - Definitions.
Subpart B - PACE Organization Application and Waiver Process
§ 460.10 - Purpose.
§ 460.12 - Application requirements.
§ 460.14 - [Reserved]
§ 460.16 - [Reserved]
§ 460.18 - CMS evaluation of applications.
§ 460.19 - Issuance of compliance actions for failure to comply with the terms of the PACE program agreement.
§ 460.20 - Notice of CMS determination.
§ 460.22 - Service area designation.
§ 460.24 - Limit on number of PACE program agreements.
§ 460.26 - Submission and evaluation of waiver requests.
§ 460.28 - Notice of CMS determination on waiver requests.
Subpart C - PACE Program Agreement
§ 460.30 - Program agreement requirement.
§ 460.32 - Content and terms of PACE program agreement.
§ 460.34 - Duration of PACE program agreement.
Subpart D - Sanctions, Enforcement Actions, and Termination
§ 460.40 - Violations for which CMS may impose sanctions.
§ 460.42 - Suspension of enrollment or payment by CMS.
§ 460.46 - Civil money penalties.
§ 460.48 - Additional actions by CMS or the State.
§ 460.50 - Termination of PACE program agreement.
§ 460.52 - Transitional care during termination.
§ 460.54 - Termination procedures.
§ 460.56 - xxx
Subpart E - PACE Administrative Requirements
§ 460.60 - PACE organizational structure.
§ 460.62 - Governing body.
§ 460.63 - xxx
§ 460.64 - Personnel qualifications for staff with direct participant contact.
§ 460.66 - Training.
§ 460.68 - Program integrity.
§ 460.70 - Contracted services.
§ 460.71 - Oversight of direct participant care.
§ 460.72 - Physical environment.
§ 460.74 - Infection control.
§ 460.76 - Transportation services.
§ 460.78 - Dietary services.
§ 460.80 - Fiscal soundness.
§ 460.82 - Marketing.
§ 460.84 - Emergency preparedness.
§ 460.86 - Payment to individuals and entities excluded by the OIG or included on the preclusion list.
Subpart F - PACE Services
§ 460.90 - PACE benefits under Medicare and Medicaid.
§ 460.92 - Required services.
§ 460.94 - Required services for Medicare participants.
§ 460.96 - Excluded services.
§ 460.98 - Service delivery.
§ 460.100 - Emergency care.
§ 460.102 - Interdisciplinary team.
§ 460.104 - Participant assessment.
§ 460.106 - Plan of care.
Subpart G - Participant Rights
§ 460.110 - Bill of rights.
§ 460.112 - Specific rights to which a participant is entitled.
§ 460.114 - Restraints.
§ 460.116 - Explanation of rights.
§ 460.118 - Violation of rights.
§ 460.119 - Resolution of complaints in the complaints tracking module.
§ 460.120 - Grievance process.
§ 460.121 - Service determination process.
§ 460.122 - PACE organization's appeals process.
§ 460.124 - Additional appeal rights under Medicare or Medicaid.
Subpart H - Quality Improvement
§ 460.130 - General rule.
§ 460.132 - Quality improvement plan.
§ 460.134 - Minimum requirements for quality improvement program.
§ 460.136 - Internal quality improvement activities.
§ 460.138 - Committees with community input.
§ 460.140 - Additional quality assessment activities.
Subpart I - Participant Enrollment and Disenrollment
§ 460.150 - Eligibility to enroll in a PACE program.
§ 460.152 - Enrollment process.
§ 460.154 - Enrollment agreement.
§ 460.156 - Other enrollment procedures.
§ 460.158 - Effective date of enrollment.
§ 460.160 - Continuation of enrollment.
§ 460.162 - Voluntary disenrollment.
§ 460.164 - Involuntary disenrollment.
§ 460.166 - Disenrollment responsibilities.
§ 460.168 - Reinstatement in other Medicare and Medicaid programs.
§ 460.170 - Reinstatement in PACE.
§ 460.172 - Documentation of disenrollment.
Subpart J - Payment
§ 460.180 - Medicare payment to PACE organizations.
§ 460.182 - Medicaid payment.
§ 460.184 - Post-eligibility treatment of income.
§ 460.186 - PACE premiums.
Subpart K - Federal/State Monitoring
§ 460.190 - Monitoring during trial period.
§ 460.192 - Ongoing monitoring after trial period.
§ 460.194 - Corrective action.
§ 460.196 - Disclosure of review results.
§ 460.198 - Disclosure of compliance deficiencies.
Subpart L - Data Collection, Record Maintenance, and Reporting
§ 460.200 - Maintenance of records and reporting of data.
§ 460.202 - Participant health outcomes data.
§ 460.204 - Financial recordkeeping and reporting requirements.
§ 460.208 - Financial statements.
§ 460.210 - Medical records.