C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER E—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › PART 460—PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) › Subpart D—Sanctions, Enforcement Actions, and Termination

42 C.F.R. § 460.42

Suspension of enrollment or payment by CMS

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(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.

Notes of Decisions
Cited in 1 case, 2019–2019 · leading case: Senior Life York, Inc. v. Azar (M.D. Penn. 2019).
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Senior Life York, Inc. v. Azar (M.D. Penn. 2019). · cites it 2× “See 42 C.F.R. § 460.42 . A. PACE CMS can “suspend enrollment of Medicare beneficiaries after the date CMS notifies the organization of the violation” if a provider does not meet certain regulatory requirements.”
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