Current through September 30, 2024
Section 460.42 - Suspension of enrollment or payment by CMS(a)Enrollment. If a PACE organization commits one or more violations specified in § 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 § 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.