42 C.F.R. § 460.42
Suspension of enrollment or payment by CMS.
Cite as 42 C.F.R. § 460.42 (2026)
(a)
Enrollment.
If a PACE organization commits one or more violations specified in § 460.40, CMS may suspend enrollment of Medicare beneficiaries after the date CMS notifies the organization of the violation.
(b)
Payment.
If a PACE organization commits one or more violations specified in § 460.40, for individuals enrolled after the date CMS notifies the PACE organization of the violation, CMS may take the following actions:
(1) Suspend Medicare payment to the PACE organization.
(2) Deny payment to the State for medical assistance for services furnished under the PACE program agreement.
(c)
Term of suspension.
A suspension or denial of payment remains in effect until CMS is satisfied that the following conditions are met:
(1) The PACE organization has corrected the cause of the violation.
(2) The violation is not likely to recur.
- Cross-references to the CFR
- 460.40