1. A. The CMS may impose the following sanctions for violations specified in §901:

   1. 1. suspend enrollment of Medicare beneficiaries;
   2. 2. suspend Medicare payment to the PACE organization;
   3. 3. deny payment to the state for medical assistance for services furnished under the PACE program agreement. The state will suspend payments to the PACE organization when payment of the federal portion of PACE reimbursement is denied;
   4. 4. impose civil money penalties as specified in federal regulations.

2. B. CMS or the state may determine that the PACE organization is not in substantial compliance with PACE requirements, and may take one or more of the following actions:

   1. 1. condition the continuation of the PACE program agreement upon timely execution of a corrective action plan;
   2. 2. withhold some or all payments under the PACE program agreement until the organization corrects the deficiency;
   3. 3. terminate the PACE program agreement.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254, Title XIX of the Social Security Act, and 42 CFR 460 et seq.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 30:249 (February 2004), amended by the Department of Health, Bureau of Health Services Financing and the Office of Aging and Adult Services, LR 50:391 (March 2024).