Ala. Admin. Code r. 560-X-53-.11
Current through Register Vol. 42, No. 10, July 31, 2024
Section 560-X-53-.11 - PACE Organization Administrative Requirements(1) A PO must be (or be a distinct part of) an entity of a city, county, state, or tribal government, or a private not-for-profit entity organized for charitable purposes under section 501(c)(3) of the Internal Revenue Code of 1986.(2) A Program Director must be employed, or contracted with, to be responsible for the oversight and administration of the PO.(3) A Medical Director must be employed, or contracted with, to be responsible for the delivery of care for participants, clinical outcomes, and the implementation and oversight of quality assessment and improvement program.(4) An organizational chart must be established and maintained indicating the officials in the PO and any relationship(s) to other organizational entities. AMA and CMS are to be notified in writing of any organizational changes at least 14 days prior to the effective date of the changes.(5) An identifiable governing body (e.g., a Board of Directors) must be established with full legal authority and responsibility for the following: (a) Governance and operation of the PO;(b) Development of policies;(c) Management and provision of all services;(d) Establishment of personnel policies, participant health and safety policies, and an operational plan to ensure health and safety of participants;(f) Quality assessment and improvement program.(6) A Participant Advisory Committee, comprised mainly of participants or representatives, must be established to provide advice to the governing body regarding participants' concerns. Requirements for the responsibilities of the Committee are listed in §460.62.(7) Each member of the PO staff that has direct contact with participants must meet the general qualification requirements listed in §460.64. A staff member must be designated to oversee these activities and to ensure that all staff meet the requirements listed in §460.71.(8) A PO must not employ or contract with individuals or organizations with criminal convictions as described in 42 CFR 460.68. Members, or immediate family of any member, of the PO's governing body that have a direct or indirect conflict of interest in supplies or care-related service contracts with the PO must be disclosed. Formal procedures must be in place to address these issues as required in §460.68.(9) There must be a written contract between the PO and each outside organization, agency, or individual that provides administrative or care-related services not provided to participants by the PO. Each contract must meet the requirements listed in §460.68.(10) A PACE center must be designed, constructed, equipped, and maintained to ensure the safety of participants, personnel, and visitors. There must be suitable space and equipment to provide primary medical care and serve other functions required by the center. Written procedures must be established and implemented to ensure maintenance of equipment as recommended by the manufacturer. A center must meet all applicable fire safety regulations as outlined in §460.72.(11) Written procedures must be established and maintained to manage medical and non-medical emergencies and disasters that may threaten the health and safety of participants, personnel, and visitors as described in §460.72.(12) Written procedures must be established and maintained for an infection control plan to ensure a safe and sanitary environment to prevent and control the transmission of diseases and infections. Requirements for this plan are in §460.74.(13) Transportation services that are provided must be safe, accessible, and equipped to meet the needs of participants. Vehicles, including those provided by contractors, must be maintained in accordance with the recommendation of the manufacturer and be equipped to communicate with the center. All transportation personnel are to be trained to manage the special needs of participants and emergencies situations. Transportation personnel are to be informed of any pertinent changes in a participant's care by the Interdisciplinary Team.(14) Nourishing, palatable, and well-balanced meals must be furnished to meet the daily nutritional and special dietary needs of participants and must meet the requirements outlined in §460.78. Foods and dietary supplements must be procured from approved sources. Sanitary conditions must be maintained in the storing, preparation, and serving of foods. Garbage and refuse are to be disposed of properly.(15) A PO must be fiscally sound and have a documented insolvency plan that has been approved by AMA and CMS. A PO must also have show that it has arrangements to cover expenses in the event it becomes insolvent. Guidelines and requirements for these plans are outlined in §460.80.Ala. Admin. Code r. 560-X-53-.11
New Rule: Filed November 10, 2011; effective December 15, 2011.Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit.
Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 42 CFR 460 Subpart E.