[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: 42CFR460.82]



[Page 440-441]

 

                         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.  460.82  Marketing.



    (a) Information that a PACE organization must include in its 

marketing materials. (1) A PACE organization must inform the public 

about its program and give prospective participants the following 

written information:

    (i) An adequate description of the PACE organization's enrollment 

and disenrollment policies and requirements.

    (ii) PACE enrollment procedures.

    (iii) Description of benefits and services.

    (iv) Premiums.

    (v) Other information necessary for prospective participants to make 

an informed decision about enrollment.

    (2) Marketing information must be free of material inaccuracies, 

misleading information, or misrepresentations.

    (b) Approval of marketing information. (1) CMS must approve all 

marketing information before distribution by the PACE organization, 

including any revised or updated material.

    (2) CMS reviews initial marketing information as part of an entity's 

application for approval as a PACE organization, and approval of the 

application includes approval of marketing information.

    (3) Once a PACE organization is under a PACE program agreement, any 

revisions to existing marketing information and new information are 

subject to the following:

    (i) Time period for approval. CMS approves or disapproves marketing 

information within 45 days after CMS receives the information from the 

organization.

    (ii) Deemed approval. Marketing information is deemed approved, and 

the organization can distribute it, if CMS and the State administering 

agency do not disapprove the marketing material within the 45-day review 

period.

    (c) Special language requirements. A PACE organization must furnish 

printed marketing materials to prospective and current participants as 

specified below:

    (1) In English and in any other principal languages of the 

community.

    (2) In Braille, if necessary.

    (d) Information on restriction of services. (1) Marketing materials 

must inform a potential participant that he or she must receive all 

needed health care, including primary care and specialist physician 

services (other than emergency services), from the PACE organization or 

from an entity authorized by the PACE organization.

    (2) All marketing materials must state clearly that PACE 

participants may be fully and personally liable for the costs of 

unauthorized or out-of-PACE program agreement services.

    (e) Prohibited marketing practices. A PACE organization must ensure 

that its employees or its agents do not use prohibited marketing 

practices which includes the following:

    (1) Discrimination of any kind, except that marketing may be 

directed to individuals eligible for PACE by reason of their age.



[[Page 441]]



    (2) Activities that could mislead or confuse potential participants, 

or misrepresent the PACE organization, CMS, or the State administering 

agency.

    (3) Gifts or payments to induce enrollment.

    (4) Contracting outreach efforts to individuals or organizations 

whose sole responsibility involves direct contact with the elderly to 

solicit enrollment.

    (5) Unsolicited door-to-door marketing.

    (f) Marketing Plan. A PACE organization must establish, implement, 

and maintain a documented marketing plan with measurable enrollment 

objectives and a system for tracking its effectiveness.