§460.42. Suspension of enrollment or payment by CMS.
42 C.F.R. § 460.42
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.
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:
Suspend Medicare payment to the PACE organization.
Deny payment to the State for medical assistance for services furnished under the PACE program agreement.
Term of suspension. A suspension or denial of payment remains in effect until CMS is satisfied that the following conditions are met:
The PACE organization has corrected the cause of the violation.
The violation is not likely to recur.
Notes, amendments, and revision history
Authority
Authority: 42 U.S.C. 1302, 1395, 1395eee(f), and 1396u-4(f).
Source
Source: 64 FR 66279, Nov. 24, 1999, unless otherwise noted.