Regulations last checked for updates: Nov 24, 2024

Title 42 - Public Health last revised: Nov 19, 2024
§ 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.

authority: 42 U.S.C. 1302,1395,1395eee(f),and
source: 64 FR 66279, Nov. 24, 1999, unless otherwise noted.
cite as: 42 CFR 460.42