42 C.F.R. Subpart K—Federal/State Monitoring
Title 42 - Public Health
(a) Trial period review. During the trial period, CMS, in cooperation with the State administering agency, conducts comprehensive annual reviews of the operations of a PACE organization to ensure compliance with the requirements of this part. (b) Scope of review. The review includes the following: (1) An onsite visit to the PACE organization, which may include, but is not limited to, the following: (i) Review of participants' charts. (ii) Interviews with staff. (iii) Interviews with participants and caregivers. (iv) Interviews with contractors. (v) Observation of program operations, including marketing, participant services, enrollment and disenrollment procedures, grievances, and appeals. (2) A comprehensive assessment of an organization's fiscal soundness. (3) A comprehensive assessment of the organization's capacity to furnish all PACE services to all participants. (4) Any other elements that CMS or the State administering agency find necessary. (a) At the conclusion of the trial period, CMS, in cooperation with the State administering agency, continues to conduct reviews of a PACE organization, as appropriate, taking into account the quality of care furnished and the organization's compliance with all of the requirements of this part. (b) Reviews include an on-site visit at least every 2 years. (a) A PACE organization must take action to correct deficiencies identified during reviews. (b) CMS or the State administering agency monitors the effectiveness of corrective actions. (c) Failure to correct deficiencies may result in sanctions or termination, as specified in subpart D of this part. (a) CMS and the State administering agency promptly report the results of reviews under §§460.190 and 460.192 to the PACE organization, along with any recommendations for changes to the organization's program. (b) CMS and the State administering agency make the results of reviews available to the public upon request. (c) The PACE organization must post a notice of the availability of the results of the most recent review and any plans of correction or responses related to the most recent review. (d) The PACE organization must make the review results available for examination in a place readily accessible to participants.
Title 42: Public Health
PART 460—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Subpart K—Federal/State Monitoring
§ 460.190 Monitoring during trial period.
§ 460.192 Ongoing monitoring after trial period.
§ 460.194 Corrective action.
§ 460.196 Disclosure of review results.
