Ala. Admin. Code r. 560-X-53-.10

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-53-.10 - PACE Organization Enrollment And Agreement

(1) An entity that wishes to become a PO must complete an application that describes how the entity meets all the requirements to be a PO. The application must be submitted to, and approved by, AMA and CMS. AMA will include an assurance with the application sent to CMS that the entity is qualified to be a PO and that AMA is willing to enter into an agreement with the entity. CMS will then evaluate the application based on the information contained in the application, as well as information obtained by onsite visits conducted by CMS and/or AMA.

(2) The proposed service area of the PO must be included in the application. If the proposed area is already serviced by another PO, it may be excluded by CMS and AMA in order to avoid duplication of services and impairing the financial and service viability of an existing PO.

(3) CMS will notify the entity within 90 days from the receipt of the application that the application is approved or denied, or that addition information is required. If the application is denied, the entity will be notified in writing of the reason for the denial and the process for requesting reconsideration by CMS. If additional information is requested, CMS will have an additional 90 days from receipt of the requested information to make a final decision. If CMS fails to make a determination or take any action on the application within 90 days of the receipt of the application or within 90 days of receipt of the additional requested information, the application will be deemed as approved.

(4) An entity, or PO, may submit a request for a waiver of regulatory requirements to meet the needs of the organization or the area it will be servicing. The waiver must be submitted as a separate document and can be submitted with the application. Requirements to the principles listed in 42 CFR 4670.26 will not be waived.

(5) Once an application is approved, an agreement must be signed by the organization, the AMA, and an authorized official of CMS. The agreement is effective for one contract year, but may be extended each year unless any party chooses to terminate the agreement. At a minimum, the agreement must include the information required in 42 CFR 460.32.

Ala. Admin. Code r. 560-X-53-.10

Emergency rule effective May 1, 1991. Permanent rule effective August 14, 1991. Repealed: Filed April 5, 1999; effective May 10, 1999. New Rule: Filed November 10, 2011; effective December 15, 2011.

Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.

Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 42 CFR 460 Subpart B and Subpart C.