CMS Pub. 100-11, ch. 3, § 60.1

42 CFR 460.82(e)

POs and their subcontractors must not engage in direct, unsolicited contact

with non-referred prospective participants, including outbound calls.

Specifically, POs must not:

• Make unsolicited outbound calls;

• Conduct unsolicited door-to-door marketing;

• Call former participants who have disenrolled, or current participants

who are in the process of disenrolling, as a means of re-enrolling or

retaining these individuals;

• Call prospective participants who attended a PACE marketing or

informational event, unless the individual gave explicit permission at

the event for a follow-up call;

• Advertise outside of the PO’s defined service area unless such

advertising is unavoidable (e.g., advertising in print or broadcast

media with a national audience or with an audience that includes some

individuals outside of the service area); in this instance, the PO should

clearly disclose its service area; or

• Confirm receipt of marketing information unless the marketing

materials were requested by prospective participants, family members,

and/or caregivers.

POs may conduct the following activities:

• Contact their participants or their participants’ family members and/or

caregivers to conduct normal business related to enrollment in PACE,

including calls to participants who have been involuntarily disenrolled

to resolve eligibility issues;

• Call former participants after the disenrollment effective date to

conduct disenrollment surveys for quality improvement purposes.

Disenrollment surveys may be done by phone or sent by mail, but

neither calls nor mailings may include sales or marketing information;

• Call participants who gave explicit permission for a PO to contact

them;

• Provide an opt-out process for participants/family members/caregivers

who no longer wish to receive email communications;

• Return phone calls and messages from prospective participants, family

members, and/or caregivers;

• Contact participants/family members/caregivers via an automated

telephone notification to inform them about general information such

as the availability of flu shots, upcoming PACE changes, and other

important PACE information; and

• Call prospective participants, family members, and/or caregivers based

on referrals from unsolicited contacts.

Note: POs may make an initial follow-up call or mailing based on referrals

from a prospective participant’s family, friends or neighbor, or from

community partners and resources such as social workers, physician offices,

and housing managers. However, if upon initial contact, the prospective

participant/family member/caregiver shows no interest, further contact is

prohibited.