42 CFR 460.40 - Violations for which CMS may impose sanctions.

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§ 460.40 Violations for which CMS may impose sanctions.
In addition to other remedies authorized by law, CMS may impose any of the sanctions specified in §§ 460.42 and 460.46 if CMS determines that a PACE organization commits any of the following violations:
(a) Fails substantially to provide to a participant medically necessary items and services that are covered PACE services, if the failure has adversely affected (or has substantial likelihood of adversely affecting) the participant.
(b) Involuntarily disenrolls a participant in violation of § 460.164.
(c) Discriminates in enrollment or disenrollment among Medicare beneficiaries or Medicaid beneficiaries, or both, who are eligible to enroll in a PACE program, on the basis of an individual's health status or need for health care services.
(d) Engages in any practice that would reasonably be expected to have the effect of denying or discouraging enrollment, except as permitted by § 460.150, by Medicare beneficiaries or Medicaid beneficiaries whose medical condition or history indicates a need for substantial future medical services.
(e) Imposes charges on participants enrolled under Medicare or Medicaid for premiums in excess of the premiums permitted.
(f) Misrepresents or falsifies information that is furnished—
(1) To CMS or the State under this part; or
(2) To an individual or any other entity under this part.
(g) Prohibits or otherwise restricts a covered health care professional from advising a participant who is a patient of the professional about the participant's health status, medical care, or treatment for the participant's condition or disease, regardless of whether the PACE program provides benefits for that care or treatment, if the professional is acting within his or her lawful scope of practice.
(h) Operates a physician incentive plan that does not meet the requirements of section 1876(i)(8) of the Act.
(i) Employs or contracts with any individual who is excluded from participation in Medicare or Medicaid under section 1128 or section 1128A of the Act (or with any entity that employs or contracts with that individual) for the provision of health care, utilization review, medical social work, or administrative services.

Title 42 published on 2013-10-01

no entries appear in the Federal Register after this date.

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United States Code

Title 42 published on 2013-10-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 42 CFR 460 after this date.

  • 2014-02-21; vol. 79 # 35 - Friday, February 21, 2014
    1. 79 FR 9872 - Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Extension of Comment Period
      GPO FDSys XML | Text
      DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services
      Proposed rule; extension of the comment period.
      The comment period for the proposed rule published in the December 27, 2013 Federal Register (78 FR 79082 through 79200) is extended to March 31, 2014.
      42 CFR Parts 403, 416, 418, 441, 460, 482, 483, 484, 485, 486, 491, and 494