42 C.F.R. § 460.42 Suspension of enrollment or payment by CMS.
Title 42 - Public Health
(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.
Title 42: Public Health
PART 460—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Subpart D—Sanctions, Enforcement Actions, and Termination
§ 460.42 Suspension of enrollment or payment by CMS.
