[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR460.32]



[Page 430-431]

 

                         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 

 

                    Subpart C_PACE Program Agreement

 

Sec.  460.32  Content and terms of PACE program agreement.



    (a) Required content. A PACE program agreement must include the 

following information:

    (1) A designation of the service area of the organization's program. 

The area may be identified by county, zip code, street boundaries, 

census tract, block, or tribal jurisdictional area, as applicable. CMS 

and the State administering agency must approve any change in the 

designated service area.

    (2) The organization's commitment to meet all applicable 

requirements under Federal, State, and local laws and regulations, 

including provisions of the Civil Rights Act, the Age Discrimination 

Act, and the Americans With Disabilities Act.

    (3) The effective date and term of the agreement.

    (4) A description of the organizational structure of the PACE 

organization and information on administrative contacts, including the 

following:

    (i) Name and phone number of the program director.

    (ii) Name of all governing body members.

    (iii) Name and phone number of a contact person for the governing 

body.

    (5) A participant bill of rights approved by CMS and an assurance 

that the rights and protections will be provided.

    (6) A description of the process for handling participant grievances 

and appeals.

    (7) A statement of the organization's policies on eligibility, 

enrollment, voluntary disenrollment, and involuntary disenrollment.

    (8) A description of services available to participants.

    (9) A description of the organization's quality assessment and 

performance improvement program.

    (10) A statement of the levels of performance required by CMS on 

standard quality measures.

    (11) A statement of the data and information required by CMS and the 

State administering agency to be collected on participant care.

    (12) The capitation rates for Medicare and Medicaid.

    (13) A description of procedures that the organization will follow 

if the PACE program agreement is terminated.

    (b) Optional content. (1) An agreement may provide additional 

requirements for individuals to qualify as PACE program eligible 

individuals, in accordance with Sec.  460.150(b)(4).

    (2) An agreement may contain any additional terms and conditions 

agreed



[[Page 431]]



to by the parties if the terms and conditions are consistent with 

sections 1894 and 1934 of the Act and regulations in this part.