(a)Information that a PACE organization must include in its marketing materials.
(1) A PACE organization must inform the public about its program and give prospective participants the following written information:
(i) An adequate description of the PACE organization's enrollment and disenrollment policies and requirements.
(ii) PACE enrollment procedures.
(iii) Description of benefits and services.
(v) Other information necessary for prospective participants to make an informed decision about enrollment.
(2) Marketing information must be free of material inaccuracies, misleading information, or misrepresentations.
(b)Approval of marketing information.
(1) CMS must approve all marketing information before distribution by the PACE organization, including any revised or updated material.
(2) CMS reviews initial marketing information as part of an entity's application for approval as a PACE organization, and approval of the application includes approval of marketing information.
(3) Once a PACE organization is under a PACE program agreement, any revisions to existing marketing information and new information are subject to the following:
(i)Time period for approval. CMS approves or disapproves marketing information within 45 days after CMS receives the information from the organization.
(ii)Deemed approval. Marketing information is deemed approved, and the organization can distribute it, if CMS and the State administering agency do not disapprove the marketing material within the 45-day review period.
(c)Special language requirements. A PACE organization must furnish printed marketing materials to prospective and current participants as specified below:
(1) In English and in any other principal languages of the community.
(2) In Braille, if necessary.
(d)Information on restriction of services.
(1) Marketing materials must inform a potential participant that he or she must receive all needed health care, including primary care and specialist physician services (other than emergency services), from the PACE organization or from an entity authorized by the PACE organization.
(2) All marketing materials must state clearly that PACE participants may be fully and personally liable for the costs of unauthorized or out-of-PACE program agreement services.
(e)Prohibited marketing practices. A PACE organization must ensure that its employees or its agents do not use prohibited marketing practices which includes the following:
(1) Discrimination of any kind, except that marketing may be directed to individuals eligible for PACE by reason of their age.
(2) Activities that could mislead or confuse potential participants, or misrepresent the PACE organization, CMS, or the State administering agency.
(3) Gifts or payments to induce enrollment.
(4) Contracting outreach efforts to individuals or organizations whose sole responsibility involves direct contact with the elderly to solicit enrollment.
(5) Unsolicited door-to-door marketing.
(f)Marketing Plan. A PACE organization must establish, implement, and maintain a documented marketing plan with measurable enrollment objectives and a system for tracking its effectiveness.
Title 42 published on 2013-10-01
no entries appear in the Federal Register after this date.
This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.