US · guidance
CMS Pub. 100-11, ch. 14, § 20.3
Charges to the Individual or Entities
The PACE organization may charge other individuals or entities for PACE services
covered under Medicare for which Medicare is not the primary payer as follows:
• If a Medicare participant receives from a PACE organization covered services
that are also covered under State or Federal workers’ compensation, any no-fault insurance, any liability insurance policy or plan, including a self-insured
plan, group health plan or large group health plan, the PACE organization
may charge any of the following:
ο The insurance carrier, the employer, or any other entity that is liable for
payment for the services under Part 411; and
ο The Medicare participant, to the extent that he or she has been paid by the
carrier, employer, or entity.
[42 CFR § 460.180(d)(3), (4), and (5)]
History
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
23579f3a39372c46331c69604f247060013eb8715c52d370f0ea120f78d06955
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