[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: 42CFR460.42]



[Page 418]

 

                         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 D_Sanctions, Enforcement Actions, and Termination

 

Sec. 460.42  Suspension of enrollment or payment by CMS.



    (a) Enrollment. If a PACE organization commits one or more 

violations specified in Sec. 460.40, CMS may suspend enrollment of 

Medicare beneficiaries after the date CMS notifies the organization of 

the violation.

    (b) Payment. If a PACE organization commits one or more violations 

specified in Sec. 460.40, for individuals enrolled after the date CMS 

notifies the PACE organization of the violation, CMS may take the 

following actions:

    (1) Suspend Medicare payment to the PACE organization.

    (2) Deny payment to the State for medical assistance for services 

furnished under the PACE program agreement.

    (c) Term of suspension. A suspension or denial of payment remains in 

effect until CMS is satisfied that the following conditions are met:

    (1) The PACE organization has corrected the cause of the violation.

    (2) The violation is not likely to recur.