CMS Pub. 100-11, ch. 16, § 70

CMS or the State Administering Agency may terminate a PACE Program Agreement at

any time for cause and a PACE organization may terminate an agreement after

appropriate notice to CMS, State Administering Agency and its participants. CMS or the

State Administering Agency may terminate a PACE Program Agreement with the PACE

organization for cause including, but not limited to, the following:

• There are significant deficiencies in the quality of care furnished to

participants or the PACE organization has failed to comply substantially with

conditions for a PACE program or PACE organization under the Part 460

regulations or with the terms of its PACE Program Agreement; and, within 30

days of the date of receipt of the written notice regarding the deficiencies, the

PACE organization failed to develop and successfully initiate a plan to correct

the deficiencies or failed to continue implementation of such a plan, or CMS

and the State Administering Agency determined that the deficiencies cannot

be corrected; or

• CMS or the State Administering Agency determines that the PACE

organization cannot ensure the health and safety of its participants. The

determination may result from the identification of deficiencies that CMS or

the State Administering Agency determines cannot be corrected.

If the PACE organization initiates the termination, it is required to give CMS and the

State Administering Agency 90 days notice and participants 60 days notice before

termination in order to provide sufficient time to transition participants to alternative

care. If a participant is eligible for Medicaid, the State should provide assistance in

arranging for the alternative care. Neither the State nor CMS considers termination

lightly. The primary concern is protecting the health and safety of the participant and all

possible ramifications of terminating a program agreement, including the likelihood of

participants becoming institutionalized, will be considered before taking such severe

action.

[42 CFR § 460.50; 71 FR 71261 (Dec. 8, 2006)]