[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: 42CFR460.70]



[Page 435-436]

 

                         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 E_PACE Administrative Requirements

 

Sec.  460.70  Contracted services.



    (a) General rule. The PACE organization must have a written contract 

with each outside organization, agency, or individual that furnishes 

administrative or care-related services not furnished directly by the 

PACE organization except for emergency services as described in Sec.  

460.100.

    (b) Contract requirements. A contract between a PACE organization 

and a contractor must meet the following requirements:

    (1) The PACE organization must contract only with an entity that 

meets all applicable Federal and State requirements, including, but not 

limited to, the following:

    (i) An institutional contractor, such as a hospital or skilled 

nursing facility, must meet Medicare or Medicaid participation 

requirements.

    (ii) A practitioner or supplier must meet Medicare or Medicaid 

requirements applicable to the services it furnishes.

    (iii) A contractor must comply with the requirements of this part 

with respect to service delivery, participant rights, and quality 

assessment and performance improvement activities.

    (2) A contractor must be accessible to participants, located either 

within or



[[Page 436]]



near the PACE organization's service area.

    (3) A PACE organization must designate an official liaison to 

coordinate activities between contractors and the organization.

    (c) List of contractors. A current list of contractors must be on 

file at the PACE center and a copy must be provided to anyone upon 

request.

    (d) Copies of signed contracts. The PACE organization must furnish a 

copy of each signed contract for inpatient care to CMS and the State 

administering agency.

    (e) Content of contract. Each contract must be in writing and 

include the following information:

    (1) Name of contractor.

    (2) Services furnished (including work schedule if appropriate).

    (3) Payment rate and method.

    (4) Terms of the contract, including beginning and ending dates, 

methods of extension, renegotiation, and termination.

    (5) Contractor agreement to do the following:

    (i) Furnish only those services authorized by the PACE 

interdisciplinary team.

    (ii) Accept payment from the PACE organization as payment in full, 

and not bill participants, CMS, the State administering agency, or 

private insurers.

    (iii) Hold harmless CMS, the State, and PACE participants if the 

PACE organization does not pay for services performed by the contractor 

in accordance with the contract.

    (iv) Not assign the contract or delegate duties under the contract 

unless it obtains prior written approval from the PACE organization.

    (v) Submit reports required by the PACE organization.

    (vi) Agree to perform all the duties related to its position as 

specified in this part.

    (vii) Participate in interdisciplinary team meeting as required.

    (viii) Agree to be accountable to the PACE organization.

    (ix) Cooperate with the competency evaluation program and direct 

participant care requirements specified in Sec.  460.71.

    (f) Contracting with another entity to furnish PACE Center services. 

(1) A PACE organization may only contract for PACE Center services if it 

is fiscally sound as defined in Sec.  460.80(a) of this part and has 

demonstrated competence with the PACE model as evidenced by successful 

monitoring by CMS and the State administering agency.

    (2) The PACE organization retains responsibility for all 

participants and may only contract for the PACE Center services 

identified in Sec.  460.98(d).



[64 FR 66279, Nov. 24, 1999, as amended at 67 FR 61505, Oct. 1, 2002]