Ala. Admin. Code r. 560-X-53-.17

Current through Register Vol. 42, No. 10, July 31, 2024

Section 560-X-53-.17 - Sanctions And Enforcement Actions

(1) Penalties and sanctions may be imposed by CMS for a PO if it is determined that the PO has committed any of the violations listed n §460.40. Penalties and/or sanction will be imposed in addition to any other remedies authorized by law.

(2) CMS may also elect to suspend the enrollment of Medicare beneficiaries. CMS may also suspend Medicare payments to the PO or deny payment to AMA for medical assistance for services provided under the PACE agreement. Limitations for civil monetary penalties are addressed in §460.46. The penalties and sanctions imposed will be effective until CMS determines the cause of the violation has been corrected or the violation will not likely recur.

(3) As specified in §460.48, if CMS or AMA determine that a PO is not in compliance, one or more of the following actions will be taken:

(a) Condition the continuation of the PACE agreement upon timely execution of a corrective action plan,

(b) Withhold some or all payments under the PACE agreement until the deficiency is corrected,

(c) Terminate the PACE agreement.

Ala. Admin. Code r. 560-X-53-.17

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; 4 2 CFR 460 Subpart D.