CMS Pub. 100-11, ch. 17, § 40

The PACE Program Agreement is the contract executed between CMS, State

Administering Agency and the PACE organization upon approval of a permanent PACE

provider application.

This three-party contract governs provider operations and is signed by the

aforementioned parties. A PACE program agreement must include the following:

• A designation of the service area of the organization’s program. The area may

be identified by county, zip code, street boundaries, census track, block, or

tribal jurisdictional area, as applicable. CMS and the State Administering

Agency must approve any change in the designated service area;

• The organization’s commitment to meet all applicable requirements under

Federal, State, and local laws and regulations, including provisions of the

Civil Rights Act, the Age Discrimination Act, and the Americans With

Disabilities Act;

• The effective date and term of the agreement;

• A description of the organizational structure of the PACE organization and

information on administrative contacts including the name and phone number

of the program director, the name of all governing body members, and the

name and phone number of a contact person for the governing body;

• A participant bill of rights approved by CMS and an assurance that the rights

and protections will be provided;

• A description of the process for handing participant grievances and appeals;

• A statement of the organization’s policies on eligibility, enrollment, voluntary

disenrollment, and involuntary disenrollment;

• A description of services available to participants;

• A description of the organization’s quality assessment and performance

improvement program;

• A statement of the levels of performance required by CMS on standard quality

measures;

• A statement of the data and information required by CMS and the State

Administering Agency to be collected on participant care;

• The Medicaid capitation rate and the methodology used to calculate the

Medicare capitation rate; and

• A description of procedures that the organization will follow if the PACE

program agreement is terminated.

Additionally, an agreement may provide additional requirements for individuals to

qualify as PACE program eligible individuals in accordance with 42 CFR §

460.150(b)(4) and may contain any additional terms and conditions agreed to by the

parties if the terms and conditions are consistent with sections 1894 and 1934 of the Act

and the Part 460 regulations.

Additional information about the program agreement can be found on the CMS website

at: http://www.cms.hhs.gov/PACE/06_ProviderApplicationandRelatedResources.asp#To

pOfPage.

The program agreement is effective for a contract year and may be extended for

subsequent contract years in the absence of a notice by a party (CMS, State

Administering Agency, or the PACE organization) to terminate the agreement. The first

contract year can extend up to 23 months, that is, to December 31st of the year following

the effective date of the contract.

CMS or the State Administering Agency may terminate the program agreement at any

time for cause, including, but not limited to, uncorrected deficiencies in the quality of

care furnished to participants, the PACE organization’s failure to comply substantially

with the conditions for a PACE program, or non-compliance with the terms of the

agreement. The PACE organization may terminate the program agreement after timely

notice to CMS, the State Administering Agency and the participants. Notifications shall

be made as follows: 90 days before termination to CMS and the State Administering

Agency and 60 days before termination to the participants.

[42 CFR §§ 460.6, 460.30(b), 460.32, 460.34, 460.50]