1. A. The PACE Organization Provider Agreement shall specify the methods by which the PACE provider will assure the Department that its marketing plans, procedures, and materials are accurate and do not mislead, confuse, or defraud the Department or potential PACE participants.
2. B. The PACE provider's marketing plan and all marketing procedures and materials require approval by the Department before implementation and utilization.

3. C. The PACE provider may not participate in:

   1. (1) Activities described in 42 CFR §460.82(e); or
   2. (2) Face-to-face or telephone contact with a participant, or otherwise soliciting a participant who is not a PACE provider’s participant, unless authorized by the Department or initiated by the participant.
4. D. Subject to prior approval by the Department, a PACE provider may engage in marketing activities designed to make [recipient] participants aware of the PACE provider's availability as well as any special services offered. Addressee-blind informational mailings to an entire zip code may be used.

5. E. Enrollment Agreement and PACE Participant Enrollment Materials.

   1. (1) The PACE provider shall distribute the enrollment agreement within 14 days of the PACE participant's effective date of coverage with the PACE Program.

   2. (2) At a minimum the information in the enrollment agreement shall contain the following PACE participant enrollment materials which shall remain with the PACE participant:

      1. (a) Location or locations and office hours of the PACE providers;
      2. (b) Telephone number or numbers to call for more information;
      3. (c) Choice and use of primary care providers and policies on changing primary care providers;
      4. (d) How to access urgent care services and advice;
      5. (e) How and when to use emergency services including ambulance;
      6. (f) Information on the grievance and appeals process, including confidentiality and requesting an administrative hearing;
      7. (g) How to access interpreter services including sign interpreters;
      8. (h) PACE participant rights and responsibilities;
      9. (i) PACE participant's possible responsibility for charges including Medicare deductibles and coinsurances if the participant goes outside of the PACE Program for nonemergency care, or obtains noncovered services or services not authorized by the interdisciplinary team;
      10. (j) A clear statement that plan of care decisions are determined by the participant's interdisciplinary team;
      11. (k) Information on the availability of social services and assistance in placement in community-based housing and facilities;
      12. (l) Information on advance directives and physician order for life sustaining treatment;
      13. (m) How to obtain copies of the PACE participant's records;
      14. (n) How to obtain nonemergency ambulance services and other medical transportation to appointments, as appropriate;
      15. (o) Explanation of covered and noncovered services;
      16. (p) How to obtain prescriptions; and
      17. (q) Confidentiality policy.
   3. (3) The PACE provider shall review the enrollment agreement for accuracy at least yearly and update it with new or corrected information as needed to reflect the PACE provider's internal changes and regulatory changes. If changes impact the PACE participants' ability to use services or benefits, the PACE provider shall distribute the updated materials to all PACE participants after approval by the Department.
   4. (4) The provider shall offer orientation to the PACE program to new participants in person within 30 days of enrollment.

Authority: Health-General Article, §2-104(b), 15-103, and 15-105, Annotated Code of Maryland

Effective date:

Regulations .01—.25 adopted as an emergency provision effective November 1, 2002 (29:25 Md. R. 1979); adopted permanently effective April 28, 2003 (30:8 Md. R. 540)

Regulation .01B amended effective October 14, 2013 (40:20 Md. R. 1652); August 19, 2024 (51:16 Md, R. 742); July 21, 2025 (52:14 Md. R. 713)

Regulation .03 amended effective January 29, 2018 (45:2 Md R. 68); July 21, 2025 (52:14 Md. R. 713)

Regulation .04 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .05A, B amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .06 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .07 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .09B amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .11E amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .12 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .15 amended effective August 19, 2024 (51:16 Md, R. 742); July 21, 2025 (52:14 Md. R. 713)

Regulation .16A amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .18F amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .20A amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .21 amended effective August 19, 2024 (51:16 Md, R. 742); July 21, 2025 (52:14 Md. R. 713)

Regulation .22 amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .23 amended effective August 19, 2024 (51:16 Md, R. 742)

Regulation .23B amended effective July 21, 2025 (52:14 Md. R. 713)

Regulation .24C amended effective July 21, 2025 (52:14 Md. R. 713)