Ala. Admin. Code r. 560-X-53-.18

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

Section 560-X-53-.18 - Termination Of A PACE Program Agreement

(1) CMS or AMA may terminate a PO agreement at anytime for cause due to, but not limited to, circumstances listed in §460.50 (b) and (c).

(2) If CMS or AMA terminates a PO agreement, the PO will first be provided a reasonable opportunity to develop and implement a corrective action plan to rectify the reason(s) for the termination. The PO will also be provided a reasonable notice and opportunity for a hearing, including the right to appeal an initial determination, before the agreement is terminated. An agreement may be terminated immediately if it is determined that the health and safety of the Participants are at risk due to the reason(s) for the termination of the agreement.

(3) A PO may terminate an agreement after timely notice to CMS, AMA, and Participants. A 90-day notice must be provided to CMS and AMA. A 60-day notice must be provided to Participants.

(4) A detailed written plan describing actions to be taken for the termination must be developed by the PO. The actions must include written notice to CMS, AMA, Participants, and the community informing them of the termination of the agreement and transition procedures. The PO must assist Participants in obtaining necessary transitional care through referrals and make medical records available to the new providers. Assistance is to be given to Participants for reinstatement of Medicaid and Medicare benefits as applicable. The plan must also include information regarding the termination of marketing and enrollment activities.

Ala. Admin. Code r. 560-X-53-.18

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.