[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: 42CFR460.26]



[Page 416]

 

                         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 B_PACE Organization Application and Waiver Process

 

Sec. 460.26  Submission and evaluation of waiver requests.



    (a) A PACE organization must submit its waiver request through the 

State administering agency for initial review. The State administering 

agency forwards waiver requests to CMS along with any concerns or 

conditions regarding the waiver.

    (b) CMS evaluates a waiver request from a PACE organization on the 

basis of the following information:

    (1) The adequacy of the description and rationale for the waiver 

provided by the PACE organization, including any additional information 

requested by CMS.

    (2) Information obtained by CMS and the State administering agency 

in on-site reviews and monitoring of the PACE organization.

    (c) Requirements related to the following principles may not be 

waived:

    (1) A focus on frail elderly qualifying individuals who require the 

level of care provided in a nursing facility.

    (2) The delivery of comprehensive, integrated acute and long-term 

care services.

    (3) An interdisciplinary team approach to care management and 

service delivery.

    (4) Capitated, integrated financing that allows the provider to pool 

payments received from public and private programs and individuals.

    (5) The assumption by the provider of full financial risk.



[67 FR 61505, Oct. 1, 2002; 67 FR 63966, Oct. 16, 2002]



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