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Electronic Code of Federal Regulations

e-CFR data is current as of December 4, 2019

Title 42Chapter IVSubchapter EPart 460


TITLE 42—Public Health

CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED)

SUBCHAPTER E—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)

PART 460—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)

rule

Subpart A—BASIS, SCOPE, AND DEFINITIONS

§460.2
Basis.
§460.3
Part D program requirements.
§460.4
Scope and purpose.
§460.6
Definitions.
rule

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.
§460.20
Notice of CMS determination.
§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.
rule

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.
rule

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.
rule

Subpart E—PACE ADMINISTRATIVE REQUIREMENTS

§460.60
PACE organizational structure.
§460.62
Governing body.
§460.63
Compliance oversight requirements.
§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.
rule

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.
rule

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.
§460.120
Grievance process.
§460.122
PACE organization's appeals process.
§460.124
Additional appeal rights under Medicare or Medicaid.
rule

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.
rule

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.
rule

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.
rule

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.
rule

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.

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