CMS Pub. 100-11, ch. 17, § 10

Responsibilities

(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11)

The regulations issued by CMS for PACE, issued November 24, 1999, established

requirements for PACE under the Medicare and Medicaid programs. The second

regulation published on October 1, 2002, incorporated revisions to the original regulation,

implementing Section 903 of MIPPA (Pub. L. 106–554) by establishing a process

through which PACE organizations may request waiver of certain regulatory

requirements. In addition, it provided for greater flexibility in adapting the PACE service

delivery model to the needs of the particular organization and removed the requirement

that PACE organizations directly employ the interdisciplinary team, the program director,

and medical director and allowed for these positions to be contracted. The final rule

incorporating response to comments and updates to the regulation was published

December 8, 2006.

Section 1905(a)(26) of the Act, as added by Section 4802(a)(1) of the BBA, provided

authority for States to elect PACE as an optional Medicaid benefit. States notify CMS

that they have elected PACE as an option via a State Plan Amendment that is to be

submitted to CMS by the State Medicaid Agency. Each State is required to have a State

Administering Agency that is responsible for administering PACE Program Agreements

in their State. The State Medicaid Agency may or may not be the State Administering

Agency. The State Administering Agency closely cooperates with CMS in establishing

procedures for entering into, extending, and terminating PACE Program Agreements.

The State Administering Agency also cooperates with CMS in conducting oversight

reviews of PACE programs and has the authority to terminate a PACE Program

Agreement for cause.

The State Administering Agency is responsible for conducting a readiness review during

the application approval process to ensure that the PACE center meets the regulatory

requirements for environment and staffing.

It is the responsibility of the PACE organization and the State Administering Agency to

validate the information contained in each application. The Director of the State

Administering Agency confirms review and approval of the application by submitting a

signed certification with the application.