42 C.F.R. § 460.42

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.

42 C.F.R. §460.42