CMS Pub. 100-11, ch. 13, § 40.4

Unless a PACE participant is Medicaid eligible, he or she is responsible for paying the

Part B premium. CMS regulations specifically prohibit PACE organizations from

offering gifts or payments to induce enrollment. Thus, the payment of Part B premiums

by a PACE organization would essentially constitute an inducement for certain

individuals (those who pay Part B premiums out of pocket) to enroll in PACE.

Such payment may also violate Section 231(h) of the Health Insurance Portability and

Accountability Act of 1996 [Section 1128(A)(5) of the Social Security Act, codified at 42

U.S.C. Section 1320a7a(a)(5)]. That provision imposes civil money penalties on parties

who provide inducements to Medicare or Medicaid beneficiaries that they know or

should know are likely to influence a beneficiary's choice of a provider, practitioner, or

supplier of Medicare or Medicaid items or services. Although the Office of the Inspector

General has not issued an advisory opinion on this topic with respect to PACE, the OIG

has reviewed similar proposals from Medicare fee-for-service providers and managed

care organizations and has found them to be inappropriate.

[42 CFR § 460.82(e)(3)]