[Code of Federal Regulations]
[Title 42, Volume 3]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR460.102]

[Page 424-425]
 
                         TITLE 42--PUBLIC HEALTH
 
  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 
                 HEALTH AND HUMAN SERVICES--(Continued)
 
PART 460--PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)--Table of Contents
 
                        Subpart F--PACE Services
 
Sec. 460.102  Multidisciplinary team.

    (a) Basic requirement. A PACE organization must meet the following 
requirements:
    (1) Establish a multidisciplinary team at each center to 
comprehensively assess and meet the individual needs of each 
participant.
    (2) Assign each participant to a multidisciplinary team functioning 
at the PACE center that the participant attends.
    (b) Composition of multidisciplinary team. The multidisciplinary 
team must be composed of at least the following members:
    (1) Primary care physician.
    (2) Registered nurse.
    (3) Social worker.
    (4) Physical therapist.
    (5) Occupational therapist.
    (6) Recreational therapist or activity coordinator.
    (7) Dietitian.
    (8) PACE center manager.
    (9) Home care coordinator.
    (10) Personal care attendant or his or her representative.
    (11) Driver or his or her representative.
    (c) Primary care physician. (1) Primary medical care must be 
furnished to a participant by a PACE primary care physician.
    (2) Each primary care physician is responsible for the following:
    (i) Managing a participant's medical situations.
    (ii) Overseeing a participant's use of medical specialists and 
inpatient care.
    (d) Responsibilities of multidisciplinary team. (1) The 
multidisciplinary team is responsible for the initial assessment, 
periodic reassessments, plan of care, and coordination of 24 hour care 
delivery.
    (2) Each team member is responsible for the following:
    (i) Regularly informing the multidisciplinary team of the medical, 
functional, and psychosocial condition of each participant.
    (ii) Remaining alert to pertinent input from other team members, 
participants, and caregivers.
    (iii) Documenting changes in a participant's condition in the 
participant's medical record.
    (3) Except as specified in paragraph (g) of this section, the 
members of the multidisciplinary team must serve primarily PACE 
participants.
    (e) Exchange of information between team members. The PACE 
organization must establish, implement, and maintain documented internal 
procedures governing the exchange of information between team members, 
contractors, and participants and their caregivers consistent with the 
requirements for confidentiality in Sec. 460.200(e).
    (f) Organization employees. Except as specified in paragraph (g) of 
this section, at least the following members of the multidisciplinary 
team must be employees of the PACE organization:
    (1) Primary care physician.
    (2) Registered nurse.
    (3) Social worker.
    (4) Recreational therapist or activity coordinator.
    (5) PACE center manager.
    (6) Home care coordinator.
    (7) PACE center personal care attendant.
    (g) Waivers. (1) CMS and the State administering agency may waive 
either or both of the following:
    (i) The requirement in paragraph (d)(3) of this section that members 
of the multidisciplinary team must serve primarily PACE participants.
    (ii) The requirement in paragraph (f)(1) of this section that the 
primary care physician must be an employee of the PACE organization.

[[Page 425]]

    (2) If an applicant seeking approval as a PACE organization believes 
a waiver under this paragraph is warranted, it must include a request 
for the waiver in its application and describe in detail the 
circumstances supporting the request.
    (3) CMS and the State administering agency may grant a waiver if 
they determine the following:
    (i) There is insufficient availability in the PACE organization's 
service area of individuals who meet the requirements, or State 
licensing laws make it inappropriate for the organization to employ 
physicians.
    (ii) The proposed alternative does not adversely affect the 
availability of care or the quality of care that is furnished to 
participants.

    Effective Date Note: At 67 FR 61506, Oct. 1, 2002, Sec. 460.102, 
paragraph (d)(2)(iii) was revised, paragraph (d)(3) was amended by 
removing ``Except as specified in paragraph (g) of this section'' and 
paragraphs (f) and (g) were removed, effective Oct. 31, 2002. For the 
convenience of the user, the revised text is set forth as follows:

Sec. 460.102  Interdisciplinary team.

                                * * * * *

    (d) * * *
    (2) * * *

                                * * * * *

    (iii) Documenting changes of a participant's condition in the 
participant's medical record consistent with documentation polices 
established by the medical director.

                                * * * * *