[Code of Federal Regulations] [Title 42, Volume 3] [Revised as of October 1, 2005] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR460.2] [Page 413-414] 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 A_Basis, Scope, and Definitions Sec. 460.2 Basis. Subpart A_Basis, Scope, and Definitions Sec. 460.2 Basis. 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 Priority consideration. 460.16 Special consideration. 460.18 CMS evaluation of applications. 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. Subpart E_PACE Administrative Requirements 460.60 PACE organizational structure. 460.62 Governing body. 460.64 Personnel qualifications. 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. 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. 460.120 Grievance process. 460.122 PACE organization's appeals process. 460.124 Additional appeal rights under Medicare or Medicaid. Subpart H_Quality Assessment and Performance Improvement 460.130 General rule. 460.132 Quality assessment and performance improvement plan. 460.134 Minimum requirements for quality assessment and performance improvement program. 460.136 Internal quality assessment and performance 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. [[Page 414]] 460.166 Effective date of disenrollment. 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. 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. Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395). Source: 64 FR 66279, Nov. 24, 1999, unless otherwise noted. Editorial Note: Nomenclature changes to part 460 appear at 67 FR 61504, Oct. 1, 2002. This part implements sections 1894, 1905(a), and 1934 of the Act, which authorize the following: (a) Medicare payments to, and coverage of benefits under, PACE. (b) The establishment of PACE as a State option under Medicaid to provide for Medicaid payments to, and coverage of benefits under, PACE.