CMS Pub. 100-11, ch. 7, § 40

Institutional settings include, but are not limited to, acute care hospitals, rehabilitation

hospitals and distinct part rehabilitation units of acute care hospitals, psychiatric hospitals

and distinct part psychiatric units of acute care hospitals, and critical access hospitals,

nursing facilities and skilled nursing facilities. The PACE organization must contract

only with institutional entities that meet all applicable Federal and State requirements as

well as meet the Medicare or Medicaid participation requirements. There are provider

specific Conditions of Participation for institutions that participate in the Medicare

program. Therefore, all institutional contractors must be in compliance with their

respective Conditions of Participation.

When a participant’s care needs cannot be accommodated in the PACE center clinic and

the organization extends its care options by contracting providers to deliver specialized

services, the IDT does not “hand off” the participant’s care; it expands the care team by

collaborating with contracted specialists and placing participants in more appropriate

healthcare settings to meet new needs. This concept is clearly supported by PACE

regulations governing contracted services which require the PACE organization to

maintain responsibility for the participant’s care whether the care is delivered by the

PACE organization or contractors. For example, when the PACE organization solicits

services by a contractor or contracted facility, it must specify in the contract that the

contractor furnishes only those services authorized by the PACE IDT and agrees to be

accountable to the PACE organization. Or, when participants are admitted to an

acute/long term/rehab facility or transferred temporarily, during that time away and upon

return to program the Registered Dietician is responsible for maintaining communications

as to the management of any dietary care plan changes and alters the nutrition program

accordingly to keep current with the participant’s health/medicinal/gastrointestinal

changes.

PACE organizations cannot be reticent about exerting their contractual and regulatory

authority to actively engage in the care of PACE participants placed in contracted

facilities. CMS expects the PACE organization to establish a good working relationship

with the contracted facility staff.

[42 CFR §§ 460.70; 460.78]