Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024-Remaining Provisions and Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE); Correcting Amendment, 63825-63828 [2024-17024]
Download as PDF
Federal Register / Vol. 89, No. 151 / Tuesday, August 6, 2024 / Rules and Regulations
PartCandDStarRatings@
cms.hhs.gov—Parts C and D Star Ratings
Issues.
SUPPLEMENTARY INFORMATION:
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
I. Background
42 CFR Parts 417, 422, 423, and 460
[CMS–4201–F4 and CMS–4205–F3]
RIN 0938–AV24 and 0938–AU96
Medicare Program; Changes to the
Medicare Advantage and the Medicare
Prescription Drug Benefit Program for
Contract Year 2024—Remaining
Provisions and Contract Year 2025
Policy and Technical Changes to the
Medicare Advantage Program,
Medicare Prescription Drug Benefit
Program, Medicare Cost Plan Program,
and Programs of All-Inclusive Care for
the Elderly (PACE); Correcting
Amendment
Centers for Medicare &
Medicaid Services (CMS), Department
of Health and Human Services (HHS).
ACTION: Final rule; correcting
amendment.
AGENCY:
This document corrects
technical and typographical errors in
the final rule that appeared in the April
23, 2024 Federal Register titled
‘‘Medicare Program; Changes to the
Medicare Advantage and the Medicare
Prescription Drug Benefit Program for
Contract Year 2024—Remaining
Provisions and Contract Year 2025
Policy and Technical Changes to the
Medicare Advantage Program, Medicare
Prescription Drug Benefit Program,
Medicare Cost Plan Program, and
Programs of All-Inclusive Care for the
Elderly (PACE).’’ The effective date of
the final rule was June 3, 2024.
DATES: This correcting amendment is
effective August 6, 2024.
FOR FURTHER INFORMATION CONTACT:
Carly Medosch, (410) 786–8633—
General Questions.
Naseem Tarmohamed, (410) 786–
0814—Part C and Cost Plan Issues.
Lucia Patrone, (410) 786–8621—Part
D Issues.
Kristy Nishimoto, (206) 615–2367—
Beneficiary Enrollment and Appeal
Issues.
Kelley Ordonio, (410) 786–3453—
Parts C and D Payment Issues.
Hunter Coohill, (720) 853–2804—
Enforcement Issues.
Lauren Brandow, (410) 786–9765—
PACE Issues.
Sara Klotz, (410) 786–1984—D–SNP
Issues.
Joe Strazzire, (410) 786–2775—RADV
Audit Appeals Issues.
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SUMMARY:
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In FR Doc. FR 2024–07105 of April
23, 2024 (89 FR 30448), the final rule
titled ‘‘Medicare Program; Changes to
the Medicare Advantage and the
Medicare Prescription Drug Benefit
Program for Contract Year 2024—
Remaining Provisions and Contract Year
2025 Policy and Technical Changes to
the Medicare Advantage Program,
Medicare Prescription Drug Benefit
Program, Medicare Cost Plan Program,
and Programs of All-Inclusive Care for
the Elderly (PACE)’’, there were several
typographical and technical errors that
are identified and corrected in this
correcting amendment.
II. Summary of Errors
A. Summary of Errors in the Preamble
On page 30448, we inadvertently
omitted the applicability date specific to
the Programs of All-inclusive Care for
the Elderly (PACE) Past Performance
(§§ 460.18 and 460.19) provisions.
On page 30524, we erroneously
included language regarding a proposed
provision that was not being finalized.
On page 30626, in Table FC–2, we
made a technical error in a value
presented in Table FC–2.
On page 30712, we are correcting an
inadvertent error in a reference.
On page 30766, we inadvertently
omitted language regarding the changes
being finalized in § 460.120(g).
On page 30797 and 30798, we made
a few typographical errors in Table J9.
B. Summary of Errors in the Regulations
Text
On pages 30816, 30818, 30819, 30829,
30831, and 30832, we are correcting
typographical and technical errors in
the amendatory instructions by setting
forth amendatory instructions,
regulations text or both for
§§ 422.74(d)(4)(i), 422.102(f)(4),
422.116(f)(1), 422.2274(c)(13),1
1 CMS acknowledges that certain changes to its
agent-broker compensation regulations, which were
finalized as part of the April 2024 final rule, are the
subject of pending litigation. On July 3, 2024, the
U.S. District Court for the Northern District of Texas
issued nationwide preliminary injunctions in
Americans for Beneficiary Choice v. HHS, No. 4:24–
cv–00439, and Council for Medicare Choice v. HHS,
No. 4:24–cv–00446, which enjoined the
implementation of the changes to §§ 422.2274(a),
(c), (d), and (e) and 423.2274(a), (c), (d), (e). For
additional guidance, please see the July 18, 2024
HPMS memorandum, ‘‘Updated: Contract Year
2025 Agent and Broker Compensation Rates,
Submissions, and Training and Testing
Requirements,’’ available at https://www.cms.gov/
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63825
423.44(d)(2)(iii) through (viii), and
423.100.
On page 30818, we are also correcting
a typographical error in the paragraph
reference in § 422.102(f)(4)(iii)(B).
On page 30828, we are correcting
typographical and technical errors in
the regulations text of § 422.2267(e)(34).
On pages 30837 and 30839, we are
correcting typographical errors in the
numbering of paragraphs in §§ 423.501
and 423.522, respectively.
On page 30841, we are correcting
typographical errors in the regulations
text of § 423.584.
On page 30843, we are correcting the
inadvertent omission of § 460.12(b)(3) in
the regulations text.
On page 30848, in the regulations text
for § 460.120(h)(4), we are correcting a
technical error in referencing other
applicable requirements.
III. Waiver of Proposed Rulemaking
and Delay in Effective Date
Under 5 U.S.C. 553(b) of the
Administrative Procedure Act (APA),
the agency is required to publish a
notice of the proposed rule in the
Federal Register before the provisions
of a rule take effect. Specifically, 5
U.S.C. 553 requires the agency to
publish a notice of the proposed rule in
the Federal Register that includes a
reference to the legal authority under
which the rule is proposed, and the
terms and substance of the proposed
rule or a description of the subjects and
issues involved. Further, 5 U.S.C. 553
requires the agency to give interested
parties the opportunity to participate in
the rulemaking through public comment
on a proposed rule. Similarly, section
1871(b)(1) of the Act requires the
Secretary to provide for notice of the
proposed rule in the Federal Register
and provide a period of not less than 60
days for public comment for rulemaking
to carry out the administration of the
Medicare program under title XVIII of
the Act. In addition, section 553(d) of
the APA, and section 1871(e)(1)(B)(i) of
the Social Security Act (the Act)
mandate a 30-day delay in effective date
after issuance or publication of a rule.
Sections 553(b)(B) and 553(d)(3) of the
APA provide for exceptions from the
notice and comment and delay in
effective date APA requirements. In
cases in which these exceptions apply,
sections 1871(b)(2)(C) and
1871(e)(1)(B)(ii) of the Act, also provide
exceptions from the notice and 60-day
comment period and delay in effective
date requirements of the Act. Section
about-cms/information-systems/hpms/hpmsmemos-archive-weekly/hpms-memos-wk-3-july-1519.
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553(b)(B) of the APA and section
1871(b)(2)(C) of the Act authorize an
agency to dispense with normal
rulemaking requirements for good cause
if the agency makes a finding that the
notice and comment process are
impracticable, unnecessary, or contrary
to the public interest. In addition, both
section 553(d)(3) of the APA and section
1871(e)(1)(B)(ii) of the Act allow the
agency to avoid the 30-day delay in
effective date where such delay is
contrary to the public interest and an
agency includes a statement of support.
We believe that this correcting
amendment does not constitute a rule
that would be subject to the notice and
comment or delayed effective date
requirements of the APA or section 1871
of the Act. This correcting amendment
corrects typographical and technical
errors in the preamble and regulatory
text of the final rule but does not make
substantive changes to the policies that
were adopted in the final rule. As a
result, this correcting amendment is
intended to ensure that the information
in the final rule accurately reflects the
policies adopted in that final rule.
In addition, even if this were a rule to
which the notice and comment
procedures and delayed effective date
requirements applied, we find that there
is good cause to waive such
requirements. Undertaking further
notice and comment procedures to
incorporate the regulatory text
correction in this document into the
final rule or delaying the effective date
would be unnecessary, as we are not
altering our policies or regulatory
changes, but rather, we are simply
implementing the policies and
regulatory changes that we previously
proposed, requested comment on, and
subsequently finalized.
This final rule correcting amendment
is intended solely to ensure that the
final rule and the Code of Federal
Regulations (CFR) accurately reflect
policies and regulatory changes that
have been adopted through rulemaking.
Furthermore, such notice and comment
procedures would be contrary to the
public interest because it is in the
public’s interest to ensure that the final
rule accurately reflects our policies and
regulatory changes. Therefore, we
believe we have good cause to waive the
notice and comment and effective date
requirements.
A. Corrections to the Preamble
IV. Correction of Errors
42 CFR Part 422
In FR Doc. FR 2024–07105 of April
23, 2024 (89 FR 30448), make the
following corrections:
Administrative practice and
procedure, Health facilities, Health
maintenance organizations (HMO),
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1. On page 30448, second column,
first full paragraph (continuation of the
Applicability Dates), last line, the
paragraph is corrected by adding the
following sentence:
‘‘The PACE Past Performance
provisions at §§ 460.18 and 460.19 are
applicable to PACE applications
submitted beginning January 1, 2025.’’.
2. On page 30524, second column,
first full paragraph, lines 21–25, the
phrase ‘‘electronic health record. See
section III.L.5. of this final rule for a
discussion of our proposals to enable
more widespread access to RTBTs
through the adoption of a standard.’’ is
corrected to read ‘‘electronic health
record.’’.
3. On page 30626, lower half of the
page, in the table titled ‘‘TABLE FC–2:
EXAMPLE AGENT BROKER
COMPENSATION UPDATES CY 2024–
2026,’’ third column, last row, the figure
‘‘$313’’ is corrected to read ‘‘$363’’.
4. On page 30712, third column, first
partial paragraph, line 15, the reference
‘‘May 2020 final rule’’ is corrected to
read ‘‘June 2020 final rule’’.
5. On page 30766, first column, the
fourth full paragraph, last line, the
phrase ‘‘without modification.’’ is
corrected to read ‘‘without modification
to the requirement. Additionally, we
reorganized some introductory language
at § 460.120(g), (g)(1), and (g)(2) to
reduce repetitive language that did not
affect the substance of the
requirements.’’.
6. On page 30797, in the table titled
‘‘TABLE J9: SUMMARY OF ANNUAL
INFORMATION COLLECTION
REQUIREMENTS AND BURDEN *’’,
fourth column, last row, the ‘‘-’’ is
corrected to read ‘‘1,000,000 Enrollees’’.
7. On page 30798, in the table titled
‘‘TABLE J9: SUMMARY OF ANNUAL
INFORMATION COLLECTION
REQUIREMENTS AND BURDEN *’’,
fourth column, last row, the figure
‘‘3474836’’ is corrected to read
‘‘4,474,836’’.
List of Subjects
42 CFR Part 417
Administrative practice and
procedure, Grant programs—health,
Health care, Health Insurance, Health
maintenance organizations (HMO), Loan
programs—health Medicare, and
Reporting and recordkeeping
requirements.
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Medicare, Penalties, Privacy, Reporting
and recordkeeping requirements.
42 CFR Part 423
Administrative practice and
procedure, Health facilities, Health
maintenance organizations (HMO),
Medicare, Penalties, Privacy, Reporting
and recordkeeping requirements.
42 CFR Part 460
Aged, Citizenship and naturalization,
Civil rights, Health, Health care, Health
records, Individuals with disabilities,
Medicaid, Medicare, Religious
discrimination, Reporting and
recordkeeping requirements, Sex
discrimination.
For the reasons set forth in the
preamble, the Centers for Medicare &
Medicaid Services amends 42 CFR
Chapter IV as set forth below.
PART 422—MEDICARE ADVANTAGE
PROGRAM
1. The authority citation for part 422
is revised to read as follows:
■
Authority: 42 U.S.C. 1302, 1306, 1395w–
21 through 1395w–28, and 1395hh.
2. Section 422.74 is amended by
revising paragraph (d)(4)(i) to read as
follows:
■
§ 422.74 Disenrollment by the MA
organization.
*
*
*
*
*
(d) * * *
(4) * * *
(i) Basis for disenrollment. Unless
continuation of enrollment is elected
under § 422.54, the MA organization
must disenroll an individual, and must
document the basis for such action, if
the MA organization establishes, on the
basis of a written statement from the
individual or other evidence acceptable
to CMS, that the individual has
permanently moved—
(A) Out of the MA plan’s service area
or is incarcerated as specified in
paragraph (d)(4)(v) of this section.
(B) From the residence in which the
individual resided at the time of
enrollment in the MA plan to an area
outside the MA plan’s service area, for
those individuals who enrolled in the
MA plan under the eligibility
requirements at § 422.50(a)(3)(ii) or
(a)(4).
*
*
*
*
*
■ 3. Section 422.102 is amended by
adding paragraph (f)(4) to read as
follows:
§ 422.102
*
Supplemental benefits.
*
*
(f) * * *
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*
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(4) Plan responsibilities. An MA plan
offering SSBCI must do all of the
following:
(i) Have written policies for
determining enrollee eligibility and
must document its determination that
an enrollee is a chronically ill enrollee
based on the definition in paragraph
(f)(1)(i) of this section.
(ii) Make information and
documentation related to determining
enrollee eligibility available to CMS
upon request.
(iii)(A) Have and apply written
policies based on objective criteria for
determining a chronically ill enrollee’s
eligibility to receive a particular SSBCI;
and
(B) Document the written policies
specified in paragraph (f)(4)(iii)(A) of
this section and the objective criteria on
which the written policies are based.
(iv) Document each eligibility
determination for an enrollee, whether
eligible or ineligible, to receive a
specific SSBCI and make this
information available to CMS upon
request.
(v) Maintain without modification, as
it relates to an SSBCI, evidentiary
standards for a specific enrollee to be
determined eligible for a particular
SSBCI, or the specific objective criteria
used by a plan as part of SSBCI
eligibility determinations for the full
coverage year.
*
*
*
*
*
■ 4. Section 422.116 is amended by
revising paragraph (f)(1) to read as
follows:
§ 422.116
Network adequacy.
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*
*
*
*
*
(f) * * *
(1) An MA plan may request an
exception to network adequacy criteria
in paragraphs (b) through (e) of this
section when either paragraph (f)(1)(i) or
(ii) of this section is met:
(i)(A) Certain providers or facilities
are not available for the MA plan to
meet the network adequacy criteria as
shown in the Provider Supply file for
the year for a given county and specialty
type; and
(B) The MA plan has contracted with
other providers and facilities that may
be located beyond the limits in the time
and distance criteria, but are currently
available and accessible to most
enrollees, consistent with the local
pattern of care.
(ii)(A) A facility-based InstitutionalSpecial Needs Plan (I–SNP) is unable to
contract with certain specialty types
required under § 422.116(b) because of
the way enrollees in facility-based I–
SNPs receive care; or
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(B) A facility-based I–SNP provides
sufficient and adequate access to basic
benefits through additional telehealth
benefits (in compliance with § 422.135)
when using telehealth providers of the
specialties listed in paragraph (d)(5) of
this section in place of in-person
providers to fulfill network adequacy
standards in paragraphs (b) through (e)
of this section.
*
*
*
*
*
■ 5. Section 422.2267 is amended by
revising paragraph (e)(34) to read as
follows:
§ 422.2267
content.
Required materials and
*
*
*
*
*
(e) * * *
(34) SSBCI disclaimer. This is model
content and must be used by MA
organizations that offer CMS-approved
SSBCI as specified in § 422.102(f). In the
SSBCI disclaimer, MA organizations
must include the information required
in paragraphs (i) through (iii) of this
section. MA organizations must do all of
the following:
(i) Convey the benefits mentioned are
a part of special supplemental benefits.
(ii) List the chronic condition(s) the
enrollee must have to be eligible for the
SSBCI offered by the applicable MA
plan(s), in accordance with the
following requirements.
(A) The following applies when only
one type of SSBCI is mentioned:
(1) If the number of condition(s) is
five or fewer, then list all condition(s).
(2) If the number of conditions is
more than five, then list the top five
conditions, as determined by the MA
organization, and convey that there are
other eligible conditions not listed.
(B) The following applies when
multiple types of SSBCI are mentioned:
(1) If the number of condition(s) is
five or fewer, then list all condition(s),
and if relevant, state that these
conditions may not apply to all types of
SSBCI mentioned.
(2) If the number of conditions is
more than five, then list the top five
conditions, as determined by the MA
organization, for which one or more
listed SSBCI is available, and convey
that there are other eligible conditions
not listed.
(iii) Convey that even if the enrollee
has a listed chronic condition, the
enrollee will not necessarily receive the
benefit because coverage of the item or
service depends on the enrollee being a
‘‘chronically ill enrollee’’ as defined in
§ 422.102(f)(1)(i)(A) and on the
applicable MA plan’s coverage criteria
for a specific SSBCI required by
§ 422.102(f)(4).
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63827
(iv) Meet the following requirements
for the SSBCI disclaimer in ads:
(A) For television, online, social
media, radio, or other voice-based ads,
either read the disclaimer at the same
pace as, or display the disclaimer in the
same font size as, the advertised phone
number or other contact information.
(B) For outdoor advertising (as
defined in § 422.2260), display the
disclaimer in the same font size as the
advertised phone number or other
contact information.
(v) Include the SSBCI disclaimer in all
marketing and communications
materials that mention SSBCI.
*
*
*
*
*
■ 6. Section 422.2274 is amended by
adding paragraph (c)(13) to read as
follows:
§ 422.2274 Agent, broker, and other thirdparty requirements.
*
*
*
*
*
(c) * * *
(13) Beginning with contract year
2025, ensure that no provision of a
contract with an agent, broker, or other
TPMO has a direct or indirect effect of
creating an incentive that would
reasonably be expected to inhibit an
agent or broker’s ability to objectively
assess and recommend which plan best
fits the health care needs of a
beneficiary.
*
*
*
*
*
PART 423—VOLUNTARY MEDICARE
PRESCRIPTION DRUG BENEFIT
7. The authority citation for part 423
continues to read as follows:
■
Authority: 42 U.S.C. 1302, 1306, 1395w–
101 through 1395w–152, and 1395hh.
8. Section 423.44 is amended by
revising paragraphs (d)(2)(iii) through
(viii) to read as follows:
■
§ 423.44 Involuntary disenrollment from
Part D coverage.
*
*
*
*
*
(d) * * *
(2) * * *
(iii) Effort to resolve the problem. The
PDP sponsor must make a serious effort
to resolve the problems presented by the
individual, including providing
reasonable accommodations, as
determined by CMS, for individuals
with mental or cognitive conditions,
including mental illness, Alzheimer’s
disease, and developmental disabilities.
In addition, the PDP sponsor must
inform the individual of the right to use
the PDP’s grievance procedures, through
the notices described in paragraph
(d)(2)(viii) of this section. The
individual has a right to submit any
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information or explanation that he or
she may wish to the PDP.
(iv) Documentation. The PDP
sponsor—
(A) Must document the enrollee’s
behavior, its own efforts to resolve any
problems, as described in paragraph
(d)(2)(iii) of this section, and any
extenuating circumstances;
(B) May request from CMS the ability
to decline future enrollment by the
individual; and
(C) Must submit the following:
(1) The information specified in
paragraph (d)(2)(iv)(A) of this section.
(2) Any documentation received by
the individual to CMS.
(3) Dated copies of the notices
required in paragraph (d)(2)(viii) of this
section.
(v) CMS review of the proposed
disenrollment. CMS reviews the
information submitted by the PDP
sponsor and any information submitted
by the individual (which the PDP
sponsor has submitted to CMS) to
determine if the PDP sponsor has
fulfilled the requirements to request
disenrollment for disruptive behavior. If
the PDP sponsor has fulfilled the
necessary requirements, CMS reviews
the information and make a decision to
approve or deny the request for
disenrollment, including conditions on
future enrollment, within 20 working
days. During the review, CMS ensures
that staff with appropriate clinical or
medical expertise reviews the case
before making a final decision. The PDP
sponsor is required to provide a
reasonable accommodation, as
determined by CMS, for the individual
in exceptional circumstances that CMS
deems necessary. CMS notifies the PDP
sponsor within 5 working days after
making its decision.
(vi) Exception for fallback
prescription drug plans. CMS reserves
the right to deny a request from a
fallback prescription drug plan as
defined in § 423.855 to disenroll an
individual for disruptive behavior.
(vii) Effective date of disenrollment. If
CMS permits a PDP to disenroll an
individual for disruptive behavior, the
termination is effective the first day of
the calendar month after the month in
which the PDP gives the individual
written notice of the disenrollment that
meets the requirements set forth in
paragraph (c) of this section.
(viii) Required notices. The PDP
sponsor must provide the individual
two notices prior to submitting the
request for disenrollment to CMS.
(A) The first notice, the advance
notice, informs the member that
continued disruptive behavior could
lead to involuntary disenrollment and
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provides the individual an opportunity
to cease the behavior in order to avoid
the disenrollment action.
(1) If the disruptive behavior ceases
after the member receives the advance
notice and then later resumes, the
sponsor must begin the process again.
(2) The sponsor must wait at least 30
days after sending the advance notice
before sending the second notice, during
which 30-day period the individual has
the opportunity to cease their behavior.
(B) The second notice, the notice of
intent to request CMS permission to
disenroll the member, notifies the
member that the PDP sponsor requests
CMS permission to involuntarily
disenroll the member.
(1) This notice must be provided prior
to submission of the request to CMS.
(2) These notices are in addition to
the disenrollment submission notice
required under § 423.44(c).
*
*
*
*
*
■ 9. Section 423.100 is amended by
revising the definition of ‘‘Affected
enrollee’’ to read as follows:
§ 423.100
Definitions.
*
*
*
*
*
Affected enrollee, as used in this
subpart, means a Part D enrollee who is
currently taking a covered Part D drug
that is subject to a negative formulary
change that affects the Part D enrollee’s
access to the drug during the current
plan year.
*
*
*
*
*
§ 423.501
10. Section 423.501 is amended in the
definition of ‘‘Final settlement process’’
by—
■ a. Removing paragraph (4);
■ b. Redesignating paragraph (5) as
(paragraph (4);
■ c. In newly redesignated paragraph
(4), removing the phrase ‘‘Takes final
actions’’ and adding in its place the
phrase ‘‘Takes action’’.
[Amended]
11. Section 423.522 is amended by—
a. Removing paragraphs (c) and (d);
and
■ b. Redesignating paragraphs (e) and (f)
as paragraphs (c) and (d).
■
■
§ 423.584
[Amended]
12. Section 423.584 is amended by—
a. In paragraph (b) introductory text,
removing the phrase ‘‘request for
redetermination’’ and adding in its
place the phrase ‘‘request for a
redetermination’’.
■ b. In paragraph (b)(4), removing the
phrase ‘‘specified the Part D’’ and
adding in its place the phrase ‘‘specified
in the Part D’’.
■
■
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13. The authority citation for part 460
continues to read as follows:
■
Authority: 42 U.S.C. 1302, 1395,
1395eee(f), and 1396u–4(f).
14. Section 460.12 is amended by
adding paragraph (b)(3) to read as
follows:
■
§ 460.12
Application requirements.
*
*
*
*
*
(b) * * *
(3) Any PACE application that does
not include a signed and dated State
assurances document that includes
accurate service area information and
the physical address of the PACE center,
as applicable, is considered incomplete
and invalid and will not be evaluated by
CMS.
*
*
*
*
*
§ 460.120
[Amended]
15. Section 460.120 is amended in
paragraph (h)(4) by removing the phrase
‘‘for paragraphs (h)(1) through (3) of this
section.’’ and adding in its place the
phrase ‘‘for complying with all other
requirements of this section.’’
■
Elizabeth J. Gramling,
Executive Secretary to the Department,
Department of Health and Human Services.
[FR Doc. 2024–17024 Filed 8–5–24; 8:45 am]
BILLING CODE 4120–01–P
[Amended]
■
§ 423.522
PART 460—PROGRAMS OF ALLINCLUSIVE CARE FOR THE ELDERLY
(PACE)
Frm 00016
Fmt 4700
Sfmt 4700
DEPARTMENT OF THE INTERIOR
Office of the Secretary
43 CFR Part 2
[DOI–2023–0027;DS65100000
DWSN00000.000000 24XD4523WS
DP.65102]
RIN 1090–AB28
Privacy Act Regulations; Exemption
for the Law Enforcement Records
Management System
Office of the Secretary, Interior.
Final rule.
AGENCY:
ACTION:
The Department of the
Interior (DOI) is issuing a final rule to
amend its regulations to exempt certain
records in the INTERIOR/DOI–10, DOI
Law Enforcement Records Management
System (LE RMS), system of records
from one or more provisions of the
Privacy Act of 1974 because of criminal,
civil, and administrative law
enforcement requirements.
DATES: The final rule is effective August
6, 2024.
SUMMARY:
E:\FR\FM\06AUR1.SGM
06AUR1
Agencies
[Federal Register Volume 89, Number 151 (Tuesday, August 6, 2024)]
[Rules and Regulations]
[Pages 63825-63828]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-17024]
[[Page 63825]]
=======================================================================
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 417, 422, 423, and 460
[CMS-4201-F4 and CMS-4205-F3]
RIN 0938-AV24 and 0938-AU96
Medicare Program; Changes to the Medicare Advantage and the
Medicare Prescription Drug Benefit Program for Contract Year 2024--
Remaining Provisions and Contract Year 2025 Policy and Technical
Changes to the Medicare Advantage Program, Medicare Prescription Drug
Benefit Program, Medicare Cost Plan Program, and Programs of All-
Inclusive Care for the Elderly (PACE); Correcting Amendment
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Final rule; correcting amendment.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical and typographical errors in
the final rule that appeared in the April 23, 2024 Federal Register
titled ``Medicare Program; Changes to the Medicare Advantage and the
Medicare Prescription Drug Benefit Program for Contract Year 2024--
Remaining Provisions and Contract Year 2025 Policy and Technical
Changes to the Medicare Advantage Program, Medicare Prescription Drug
Benefit Program, Medicare Cost Plan Program, and Programs of All-
Inclusive Care for the Elderly (PACE).'' The effective date of the
final rule was June 3, 2024.
DATES: This correcting amendment is effective August 6, 2024.
FOR FURTHER INFORMATION CONTACT:
Carly Medosch, (410) 786-8633--General Questions.
Naseem Tarmohamed, (410) 786-0814--Part C and Cost Plan Issues.
Lucia Patrone, (410) 786-8621--Part D Issues.
Kristy Nishimoto, (206) 615-2367--Beneficiary Enrollment and Appeal
Issues.
Kelley Ordonio, (410) 786-3453--Parts C and D Payment Issues.
Hunter Coohill, (720) 853-2804--Enforcement Issues.
Lauren Brandow, (410) 786-9765--PACE Issues.
Sara Klotz, (410) 786-1984--D-SNP Issues.
Joe Strazzire, (410) 786-2775--RADV Audit Appeals Issues.
[email protected]--Parts C and D Star Ratings
Issues.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. FR 2024-07105 of April 23, 2024 (89 FR 30448), the final
rule titled ``Medicare Program; Changes to the Medicare Advantage and
the Medicare Prescription Drug Benefit Program for Contract Year 2024--
Remaining Provisions and Contract Year 2025 Policy and Technical
Changes to the Medicare Advantage Program, Medicare Prescription Drug
Benefit Program, Medicare Cost Plan Program, and Programs of All-
Inclusive Care for the Elderly (PACE)'', there were several
typographical and technical errors that are identified and corrected in
this correcting amendment.
II. Summary of Errors
A. Summary of Errors in the Preamble
On page 30448, we inadvertently omitted the applicability date
specific to the Programs of All-inclusive Care for the Elderly (PACE)
Past Performance (Sec. Sec. 460.18 and 460.19) provisions.
On page 30524, we erroneously included language regarding a
proposed provision that was not being finalized.
On page 30626, in Table FC-2, we made a technical error in a value
presented in Table FC-2.
On page 30712, we are correcting an inadvertent error in a
reference.
On page 30766, we inadvertently omitted language regarding the
changes being finalized in Sec. 460.120(g).
On page 30797 and 30798, we made a few typographical errors in
Table J9.
B. Summary of Errors in the Regulations Text
On pages 30816, 30818, 30819, 30829, 30831, and 30832, we are
correcting typographical and technical errors in the amendatory
instructions by setting forth amendatory instructions, regulations text
or both for Sec. Sec. 422.74(d)(4)(i), 422.102(f)(4), 422.116(f)(1),
422.2274(c)(13),\1\ 423.44(d)(2)(iii) through (viii), and 423.100.
---------------------------------------------------------------------------
\1\ CMS acknowledges that certain changes to its agent-broker
compensation regulations, which were finalized as part of the April
2024 final rule, are the subject of pending litigation. On July 3,
2024, the U.S. District Court for the Northern District of Texas
issued nationwide preliminary injunctions in Americans for
Beneficiary Choice v. HHS, No. 4:24-cv-00439, and Council for
Medicare Choice v. HHS, No. 4:24-cv-00446, which enjoined the
implementation of the changes to Sec. Sec. 422.2274(a), (c), (d),
and (e) and 423.2274(a), (c), (d), (e). For additional guidance,
please see the July 18, 2024 HPMS memorandum, ``Updated: Contract
Year 2025 Agent and Broker Compensation Rates, Submissions, and
Training and Testing Requirements,'' available at https://www.cms.gov/about-cms/information-systems/hpms/hpms-memos-archive-weekly/hpms-memos-wk-3-july-15-19.
---------------------------------------------------------------------------
On page 30818, we are also correcting a typographical error in the
paragraph reference in Sec. 422.102(f)(4)(iii)(B).
On page 30828, we are correcting typographical and technical errors
in the regulations text of Sec. 422.2267(e)(34).
On pages 30837 and 30839, we are correcting typographical errors in
the numbering of paragraphs in Sec. Sec. 423.501 and 423.522,
respectively.
On page 30841, we are correcting typographical errors in the
regulations text of Sec. 423.584.
On page 30843, we are correcting the inadvertent omission of Sec.
460.12(b)(3) in the regulations text.
On page 30848, in the regulations text for Sec. 460.120(h)(4), we
are correcting a technical error in referencing other applicable
requirements.
III. Waiver of Proposed Rulemaking and Delay in Effective Date
Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA),
the agency is required to publish a notice of the proposed rule in the
Federal Register before the provisions of a rule take effect.
Specifically, 5 U.S.C. 553 requires the agency to publish a notice of
the proposed rule in the Federal Register that includes a reference to
the legal authority under which the rule is proposed, and the terms and
substance of the proposed rule or a description of the subjects and
issues involved. Further, 5 U.S.C. 553 requires the agency to give
interested parties the opportunity to participate in the rulemaking
through public comment on a proposed rule. Similarly, section
1871(b)(1) of the Act requires the Secretary to provide for notice of
the proposed rule in the Federal Register and provide a period of not
less than 60 days for public comment for rulemaking to carry out the
administration of the Medicare program under title XVIII of the Act. In
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) of
the Social Security Act (the Act) mandate a 30-day delay in effective
date after issuance or publication of a rule. Sections 553(b)(B) and
553(d)(3) of the APA provide for exceptions from the notice and comment
and delay in effective date APA requirements. In cases in which these
exceptions apply, sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the
Act, also provide exceptions from the notice and 60-day comment period
and delay in effective date requirements of the Act. Section
[[Page 63826]]
553(b)(B) of the APA and section 1871(b)(2)(C) of the Act authorize an
agency to dispense with normal rulemaking requirements for good cause
if the agency makes a finding that the notice and comment process are
impracticable, unnecessary, or contrary to the public interest. In
addition, both section 553(d)(3) of the APA and section
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay
in effective date where such delay is contrary to the public interest
and an agency includes a statement of support.
We believe that this correcting amendment does not constitute a
rule that would be subject to the notice and comment or delayed
effective date requirements of the APA or section 1871 of the Act. This
correcting amendment corrects typographical and technical errors in the
preamble and regulatory text of the final rule but does not make
substantive changes to the policies that were adopted in the final
rule. As a result, this correcting amendment is intended to ensure that
the information in the final rule accurately reflects the policies
adopted in that final rule.
In addition, even if this were a rule to which the notice and
comment procedures and delayed effective date requirements applied, we
find that there is good cause to waive such requirements. Undertaking
further notice and comment procedures to incorporate the regulatory
text correction in this document into the final rule or delaying the
effective date would be unnecessary, as we are not altering our
policies or regulatory changes, but rather, we are simply implementing
the policies and regulatory changes that we previously proposed,
requested comment on, and subsequently finalized.
This final rule correcting amendment is intended solely to ensure
that the final rule and the Code of Federal Regulations (CFR)
accurately reflect policies and regulatory changes that have been
adopted through rulemaking. Furthermore, such notice and comment
procedures would be contrary to the public interest because it is in
the public's interest to ensure that the final rule accurately reflects
our policies and regulatory changes. Therefore, we believe we have good
cause to waive the notice and comment and effective date requirements.
IV. Correction of Errors
In FR Doc. FR 2024-07105 of April 23, 2024 (89 FR 30448), make the
following corrections:
A. Corrections to the Preamble
1. On page 30448, second column, first full paragraph (continuation
of the Applicability Dates), last line, the paragraph is corrected by
adding the following sentence:
``The PACE Past Performance provisions at Sec. Sec. 460.18 and
460.19 are applicable to PACE applications submitted beginning January
1, 2025.''.
2. On page 30524, second column, first full paragraph, lines 21-25,
the phrase ``electronic health record. See section III.L.5. of this
final rule for a discussion of our proposals to enable more widespread
access to RTBTs through the adoption of a standard.'' is corrected to
read ``electronic health record.''.
3. On page 30626, lower half of the page, in the table titled
``TABLE FC-2: EXAMPLE AGENT BROKER COMPENSATION UPDATES CY 2024-2026,''
third column, last row, the figure ``$313'' is corrected to read
``$363''.
4. On page 30712, third column, first partial paragraph, line 15,
the reference ``May 2020 final rule'' is corrected to read ``June 2020
final rule''.
5. On page 30766, first column, the fourth full paragraph, last
line, the phrase ``without modification.'' is corrected to read
``without modification to the requirement. Additionally, we reorganized
some introductory language at Sec. 460.120(g), (g)(1), and (g)(2) to
reduce repetitive language that did not affect the substance of the
requirements.''.
6. On page 30797, in the table titled ``TABLE J9: SUMMARY OF ANNUAL
INFORMATION COLLECTION REQUIREMENTS AND BURDEN *'', fourth column, last
row, the ``-'' is corrected to read ``1,000,000 Enrollees''.
7. On page 30798, in the table titled ``TABLE J9: SUMMARY OF ANNUAL
INFORMATION COLLECTION REQUIREMENTS AND BURDEN *'', fourth column, last
row, the figure ``3474836'' is corrected to read ``4,474,836''.
List of Subjects
42 CFR Part 417
Administrative practice and procedure, Grant programs--health,
Health care, Health Insurance, Health maintenance organizations (HMO),
Loan programs--health Medicare, and Reporting and recordkeeping
requirements.
42 CFR Part 422
Administrative practice and procedure, Health facilities, Health
maintenance organizations (HMO), Medicare, Penalties, Privacy,
Reporting and recordkeeping requirements.
42 CFR Part 423
Administrative practice and procedure, Health facilities, Health
maintenance organizations (HMO), Medicare, Penalties, Privacy,
Reporting and recordkeeping requirements.
42 CFR Part 460
Aged, Citizenship and naturalization, Civil rights, Health, Health
care, Health records, Individuals with disabilities, Medicaid,
Medicare, Religious discrimination, Reporting and recordkeeping
requirements, Sex discrimination.
For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services amends 42 CFR Chapter IV as set forth below.
PART 422--MEDICARE ADVANTAGE PROGRAM
0
1. The authority citation for part 422 is revised to read as follows:
Authority: 42 U.S.C. 1302, 1306, 1395w-21 through 1395w-28, and
1395hh.
0
2. Section 422.74 is amended by revising paragraph (d)(4)(i) to read as
follows:
Sec. 422.74 Disenrollment by the MA organization.
* * * * *
(d) * * *
(4) * * *
(i) Basis for disenrollment. Unless continuation of enrollment is
elected under Sec. 422.54, the MA organization must disenroll an
individual, and must document the basis for such action, if the MA
organization establishes, on the basis of a written statement from the
individual or other evidence acceptable to CMS, that the individual has
permanently moved--
(A) Out of the MA plan's service area or is incarcerated as
specified in paragraph (d)(4)(v) of this section.
(B) From the residence in which the individual resided at the time
of enrollment in the MA plan to an area outside the MA plan's service
area, for those individuals who enrolled in the MA plan under the
eligibility requirements at Sec. 422.50(a)(3)(ii) or (a)(4).
* * * * *
0
3. Section 422.102 is amended by adding paragraph (f)(4) to read as
follows:
Sec. 422.102 Supplemental benefits.
* * * * *
(f) * * *
[[Page 63827]]
(4) Plan responsibilities. An MA plan offering SSBCI must do all of
the following:
(i) Have written policies for determining enrollee eligibility and
must document its determination that an enrollee is a chronically ill
enrollee based on the definition in paragraph (f)(1)(i) of this
section.
(ii) Make information and documentation related to determining
enrollee eligibility available to CMS upon request.
(iii)(A) Have and apply written policies based on objective
criteria for determining a chronically ill enrollee's eligibility to
receive a particular SSBCI; and
(B) Document the written policies specified in paragraph
(f)(4)(iii)(A) of this section and the objective criteria on which the
written policies are based.
(iv) Document each eligibility determination for an enrollee,
whether eligible or ineligible, to receive a specific SSBCI and make
this information available to CMS upon request.
(v) Maintain without modification, as it relates to an SSBCI,
evidentiary standards for a specific enrollee to be determined eligible
for a particular SSBCI, or the specific objective criteria used by a
plan as part of SSBCI eligibility determinations for the full coverage
year.
* * * * *
0
4. Section 422.116 is amended by revising paragraph (f)(1) to read as
follows:
Sec. 422.116 Network adequacy.
* * * * *
(f) * * *
(1) An MA plan may request an exception to network adequacy
criteria in paragraphs (b) through (e) of this section when either
paragraph (f)(1)(i) or (ii) of this section is met:
(i)(A) Certain providers or facilities are not available for the MA
plan to meet the network adequacy criteria as shown in the Provider
Supply file for the year for a given county and specialty type; and
(B) The MA plan has contracted with other providers and facilities
that may be located beyond the limits in the time and distance
criteria, but are currently available and accessible to most enrollees,
consistent with the local pattern of care.
(ii)(A) A facility-based Institutional-Special Needs Plan (I-SNP)
is unable to contract with certain specialty types required under Sec.
422.116(b) because of the way enrollees in facility-based I-SNPs
receive care; or
(B) A facility-based I-SNP provides sufficient and adequate access
to basic benefits through additional telehealth benefits (in compliance
with Sec. 422.135) when using telehealth providers of the specialties
listed in paragraph (d)(5) of this section in place of in-person
providers to fulfill network adequacy standards in paragraphs (b)
through (e) of this section.
* * * * *
0
5. Section 422.2267 is amended by revising paragraph (e)(34) to read as
follows:
Sec. 422.2267 Required materials and content.
* * * * *
(e) * * *
(34) SSBCI disclaimer. This is model content and must be used by MA
organizations that offer CMS-approved SSBCI as specified in Sec.
422.102(f). In the SSBCI disclaimer, MA organizations must include the
information required in paragraphs (i) through (iii) of this section.
MA organizations must do all of the following:
(i) Convey the benefits mentioned are a part of special
supplemental benefits.
(ii) List the chronic condition(s) the enrollee must have to be
eligible for the SSBCI offered by the applicable MA plan(s), in
accordance with the following requirements.
(A) The following applies when only one type of SSBCI is mentioned:
(1) If the number of condition(s) is five or fewer, then list all
condition(s).
(2) If the number of conditions is more than five, then list the
top five conditions, as determined by the MA organization, and convey
that there are other eligible conditions not listed.
(B) The following applies when multiple types of SSBCI are
mentioned:
(1) If the number of condition(s) is five or fewer, then list all
condition(s), and if relevant, state that these conditions may not
apply to all types of SSBCI mentioned.
(2) If the number of conditions is more than five, then list the
top five conditions, as determined by the MA organization, for which
one or more listed SSBCI is available, and convey that there are other
eligible conditions not listed.
(iii) Convey that even if the enrollee has a listed chronic
condition, the enrollee will not necessarily receive the benefit
because coverage of the item or service depends on the enrollee being a
``chronically ill enrollee'' as defined in Sec. 422.102(f)(1)(i)(A)
and on the applicable MA plan's coverage criteria for a specific SSBCI
required by Sec. 422.102(f)(4).
(iv) Meet the following requirements for the SSBCI disclaimer in
ads:
(A) For television, online, social media, radio, or other voice-
based ads, either read the disclaimer at the same pace as, or display
the disclaimer in the same font size as, the advertised phone number or
other contact information.
(B) For outdoor advertising (as defined in Sec. 422.2260), display
the disclaimer in the same font size as the advertised phone number or
other contact information.
(v) Include the SSBCI disclaimer in all marketing and
communications materials that mention SSBCI.
* * * * *
0
6. Section 422.2274 is amended by adding paragraph (c)(13) to read as
follows:
Sec. 422.2274 Agent, broker, and other third-party requirements.
* * * * *
(c) * * *
(13) Beginning with contract year 2025, ensure that no provision of
a contract with an agent, broker, or other TPMO has a direct or
indirect effect of creating an incentive that would reasonably be
expected to inhibit an agent or broker's ability to objectively assess
and recommend which plan best fits the health care needs of a
beneficiary.
* * * * *
PART 423--VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT
0
7. The authority citation for part 423 continues to read as follows:
Authority: 42 U.S.C. 1302, 1306, 1395w-101 through 1395w-152,
and 1395hh.
0
8. Section 423.44 is amended by revising paragraphs (d)(2)(iii) through
(viii) to read as follows:
Sec. 423.44 Involuntary disenrollment from Part D coverage.
* * * * *
(d) * * *
(2) * * *
(iii) Effort to resolve the problem. The PDP sponsor must make a
serious effort to resolve the problems presented by the individual,
including providing reasonable accommodations, as determined by CMS,
for individuals with mental or cognitive conditions, including mental
illness, Alzheimer's disease, and developmental disabilities. In
addition, the PDP sponsor must inform the individual of the right to
use the PDP's grievance procedures, through the notices described in
paragraph (d)(2)(viii) of this section. The individual has a right to
submit any
[[Page 63828]]
information or explanation that he or she may wish to the PDP.
(iv) Documentation. The PDP sponsor--
(A) Must document the enrollee's behavior, its own efforts to
resolve any problems, as described in paragraph (d)(2)(iii) of this
section, and any extenuating circumstances;
(B) May request from CMS the ability to decline future enrollment
by the individual; and
(C) Must submit the following:
(1) The information specified in paragraph (d)(2)(iv)(A) of this
section.
(2) Any documentation received by the individual to CMS.
(3) Dated copies of the notices required in paragraph (d)(2)(viii)
of this section.
(v) CMS review of the proposed disenrollment. CMS reviews the
information submitted by the PDP sponsor and any information submitted
by the individual (which the PDP sponsor has submitted to CMS) to
determine if the PDP sponsor has fulfilled the requirements to request
disenrollment for disruptive behavior. If the PDP sponsor has fulfilled
the necessary requirements, CMS reviews the information and make a
decision to approve or deny the request for disenrollment, including
conditions on future enrollment, within 20 working days. During the
review, CMS ensures that staff with appropriate clinical or medical
expertise reviews the case before making a final decision. The PDP
sponsor is required to provide a reasonable accommodation, as
determined by CMS, for the individual in exceptional circumstances that
CMS deems necessary. CMS notifies the PDP sponsor within 5 working days
after making its decision.
(vi) Exception for fallback prescription drug plans. CMS reserves
the right to deny a request from a fallback prescription drug plan as
defined in Sec. 423.855 to disenroll an individual for disruptive
behavior.
(vii) Effective date of disenrollment. If CMS permits a PDP to
disenroll an individual for disruptive behavior, the termination is
effective the first day of the calendar month after the month in which
the PDP gives the individual written notice of the disenrollment that
meets the requirements set forth in paragraph (c) of this section.
(viii) Required notices. The PDP sponsor must provide the
individual two notices prior to submitting the request for
disenrollment to CMS.
(A) The first notice, the advance notice, informs the member that
continued disruptive behavior could lead to involuntary disenrollment
and provides the individual an opportunity to cease the behavior in
order to avoid the disenrollment action.
(1) If the disruptive behavior ceases after the member receives the
advance notice and then later resumes, the sponsor must begin the
process again.
(2) The sponsor must wait at least 30 days after sending the
advance notice before sending the second notice, during which 30-day
period the individual has the opportunity to cease their behavior.
(B) The second notice, the notice of intent to request CMS
permission to disenroll the member, notifies the member that the PDP
sponsor requests CMS permission to involuntarily disenroll the member.
(1) This notice must be provided prior to submission of the request
to CMS.
(2) These notices are in addition to the disenrollment submission
notice required under Sec. 423.44(c).
* * * * *
0
9. Section 423.100 is amended by revising the definition of ``Affected
enrollee'' to read as follows:
Sec. 423.100 Definitions.
* * * * *
Affected enrollee, as used in this subpart, means a Part D enrollee
who is currently taking a covered Part D drug that is subject to a
negative formulary change that affects the Part D enrollee's access to
the drug during the current plan year.
* * * * *
Sec. 423.501 [Amended]
0
10. Section 423.501 is amended in the definition of ``Final settlement
process'' by--
0
a. Removing paragraph (4);
0
b. Redesignating paragraph (5) as (paragraph (4);
0
c. In newly redesignated paragraph (4), removing the phrase ``Takes
final actions'' and adding in its place the phrase ``Takes action''.
Sec. 423.522 [Amended]
0
11. Section 423.522 is amended by--
0
a. Removing paragraphs (c) and (d); and
0
b. Redesignating paragraphs (e) and (f) as paragraphs (c) and (d).
Sec. 423.584 [Amended]
0
12. Section 423.584 is amended by--
0
a. In paragraph (b) introductory text, removing the phrase ``request
for redetermination'' and adding in its place the phrase ``request for
a redetermination''.
0
b. In paragraph (b)(4), removing the phrase ``specified the Part D''
and adding in its place the phrase ``specified in the Part D''.
PART 460--PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
0
13. The authority citation for part 460 continues to read as follows:
Authority: 42 U.S.C. 1302, 1395, 1395eee(f), and 1396u-4(f).
0
14. Section 460.12 is amended by adding paragraph (b)(3) to read as
follows:
Sec. 460.12 Application requirements.
* * * * *
(b) * * *
(3) Any PACE application that does not include a signed and dated
State assurances document that includes accurate service area
information and the physical address of the PACE center, as applicable,
is considered incomplete and invalid and will not be evaluated by CMS.
* * * * *
Sec. 460.120 [Amended]
0
15. Section 460.120 is amended in paragraph (h)(4) by removing the
phrase ``for paragraphs (h)(1) through (3) of this section.'' and
adding in its place the phrase ``for complying with all other
requirements of this section.''
Elizabeth J. Gramling,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2024-17024 Filed 8-5-24; 8:45 am]
BILLING CODE 4120-01-P