CMS Pub. 100-11, ch. 8, § 20.3

The IDT must perform any pre-enrollment assessments in person, and cannot substitute

assessments completed by non-PACE community providers or reports contained in

copied medical records. The PACE organization also cannot supplant the initial

comprehensive assessments with any pre-enrollment screening undertaken to determine a

prospective enrollee’s suitability for PACE services as well as eligibility for PACE

enrollment.

CMS recognizes that some PACE organizations may choose to perform some or all IDT

assessments prior to enrollment, and allows pre-enrollment assessments to fulfill the

initial assessments requirement when certain contingencies are met:

• The health status of the enrolled participant has not changed since the pre-enrollment assessments;

• If the participant’s health status has changed, the participant is reassessed per

42 CFR § 460.104 and an initial care plan developed per 42 CFR § 460.106.

The Medicare Health Outcomes Survey-Modified (HOS-M) assesses annually the frailty

of the population in PACE organizations in order to adjust plan payment rates. Initial

eligibility for payment purposes is based on community-residing participants who do not

have end-stage renal disease (ESRD) and are 55 or over. Refer to Chapter 10 of this

PACE Manual for more information regarding HOS-M.

[42 CFR § 460.180]