US · guidance
CMS Pub. 100-11, ch. 16, § 40
Suspension of Enrollment or Payment by CMS
CMS may suspend enrollment of Medicare beneficiaries due to the above mentioned
violation after the date CMS notifies the PACE organization of the violation. For
individuals enrolled after the date CMS notifies the PACE organization of the violation,
CMS may suspend Medicare payment to the PACE organization and deny payment to the
State of Federal Financial Participation for medical assistance for services furnished
under the PACE program agreement. The State Administering Agency determines if
suspension of enrollment should occur with Medicaid recipients. A suspension or denial
of payment remains in effect until CMS is satisfied that the PACE organization has
corrected the cause of the violation and the violation is not likely to recur.
[42 CFR § 460.42; 71 FR 71259 (Dec. 8, 2006)]
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
3d5f17ca8d6668c2399ef4b1ae67893b5c8b7300d604aa32f946d19fbb7e543a
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