Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-53 - PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)
Section 560-X-53-.17 - Sanctions And Enforcement Actions

Universal Citation: AL Admin Code R 560-X-53-.17

Current through Register Vol. 43, No. 02, November 27, 2024

(1) Penalties and sanctions may be imposed by CMS for a PO if it is determined that the PO has committed any of the violations listed n §460.40. Penalties and/or sanction will be imposed in addition to any other remedies authorized by law.

(2) CMS may also elect to suspend the enrollment of Medicare beneficiaries. CMS may also suspend Medicare payments to the PO or deny payment to AMA for medical assistance for services provided under the PACE agreement. Limitations for civil monetary penalties are addressed in §460.46. The penalties and sanctions imposed will be effective until CMS determines the cause of the violation has been corrected or the violation will not likely recur.

(3) As specified in §460.48, if CMS or AMA determine that a PO is not in compliance, one or more of the following actions will be taken:

(a) Condition the continuation of the PACE agreement upon timely execution of a corrective action plan,

(b) Withhold some or all payments under the PACE agreement until the deficiency is corrected,

(c) Terminate the PACE agreement.

Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.

Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 4 2 CFR 460 Subpart D.

Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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