CMS Pub. 100-11, ch. 9, § 60

The burden of documenting contractors’ compliance with applicable standards ultimately

rests with the PACE organization.

It is especially important to identify specific responsibilities of a contractor. The PACE

organization must develop its own procedures to ensure that the entity complies with the

standards of competency and quality of care.

The PACE organization must not contract with organizations or individuals who have

been excluded from the Medicare or Medicaid programs; who have been convicted of

criminal offenses related to their involvement in Medicaid, Medicare, other health

insurance or health care programs, or social service programs under Title XX of the Act;

or for those having participant contact, who would pose a potential risk because of prior

physical, sexual, drug, or alcohol abuse conviction.

The PACE organization must contract with only those entities that meet all applicable

Federal and State requirements.

All employees and contractors must meet the personnel qualifications for the physician,

registered nurse, social worker, physical therapist, occupational therapist, recreational

therapist, dietitian and driver.

Although the PACE organization is not performing the actual compliance checks (in the

case of a hospital, physician, medical equipment, or supplies), the organization must

ensure that the contractor is in compliance with the written contract. The written contract

must state that the contractor will meet all applicable Federal and State requirements

allowing the PACE organization some flexibility in determining the organizational

process that will occur to ensure their contractors meet all program requirements.

In the case of an independent contractor or provider-based organization who provides

direct participant care and has not been credentialed through a Medicare or Medicaid

contracting organization, the PACE organization will have to receive the same documents

from the contractor as they would for an employee. If the contractor is working for the

contracted organization and not independently, then the contracted organization must

forward all of their staff credentials prior to performing participant care.

The PACE organization is responsible for not only ensuring the contract staff meet

requirements at the onset of the contract, but on an ongoing basis. The contract

organization has to have a process in place to ensure this compliance and the PACE

organization has to have a process to review contract compliance. The contract

organization must have a process in place to notify the PACE organization when one of

their staff is out of compliance so that the PACE organization does not utilize that staff

member for participant care (in the case of a license expiring, other sanctions, or illegal

activity).

[42 CFR §§ 460.64; 460.68(a); 460.70(b)(1)]