Common use of Required content Clause in Contracts

Required content. A PACE program agreement must include the following information: (1) A designation of the service area of the PACE organization’s program, identified by county. The department and CMS must approve any change in the designated service area. (2) The PACE organization’s commitment to meet all applicable requirements under federal, state, and local laws and regulations, including provisions of the Civil Rights Act, the Age Discrimination Act, and the Americans with Disabilities Act. (3) The effective date and term of the agreement. (4) A description of the organizational structure of the PACE organization and information on the organization’s administrative contacts. (5) An enrollee bill of rights approved by CMS and an assurance that the listed rights and protections will be provided. (6) A description of the process for handling enrollee grievances and appeals. (7) A statement of the PACE organization’s policies on eligibility, enrollment, voluntary disenrollment, and involuntary disenrollment. (8) A description of the services available to enrollees. (9) A description of the PACE organization’s quality assessment and performance improvement program. (10) A statement of the levels of performance required in CMS standard quality measures. (11) A statement of the data and information required by the department and CMS to be collected on enrollee care. (12) The Medicaid capitation rate and the methodology used to calculate the Medicare capitation rate. (13) A description of procedures that the PACE organization will follow if the PACE program agreement is terminated, including how the organization will: 1. Inform enrollees, the community, CMS, and the department, in writing, about the organization’s termination and transition procedures. 2. Initiate contact with income maintenance staff in the local department office and assist enrollees in obtaining reinstatement of conventional Medicare and Medicaid benefits. 3. Transition enrollees’ care to other providers. 4. Terminate marketing and enrollment activities.