<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 10.09.44.04" title_num="10" subtitle_num="09" chapter_num="44" heading="Term of the PACE Organization Provider Agreement.">
  <paragraph num="A.">
    <text>The duration or term of the agreement between the Department and the PACE provider is specified in the PACE Organization Provider Agreement.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The PACE Organization Provider Agreement shall provide for automatic amendment, renegotiation, or termination, or all of the above, of the PACE Organization Provider Agreement by either party if any part of the PACE Organization Provider Agreement's provider benefit package is changed under the State Plan.</text>
  </paragraph>
  <paragraph num="C.">
    <text>Termination.</text>
    <paragraph num="(1)">
      <text>The Department may terminate immediately the PACE Organization Provider Agreement upon notification:</text>
      <paragraph num="(a)">
        <text>By the U. S. Department of Health and Human Services, that it is withdrawing federal financial participation in all or part of the cost of the PACE benefit package;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>By the Department of Budget and Management, of the unavailability of sufficient State funds for the PACE benefit package; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>That the owners or managers of the PACE provider, or other persons with substantial Medicaid Provider Agreement relationships with the PACE provider, have been convicted of certain crimes or received certain sanctions as specified in §1128 of the Social Security Act.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The Department may, at its sole discretion, offer to renegotiate any provision of the PACE Organization Provider Agreement if renegotiation would remove any of the causes of termination specified in §C(1) of this regulation. This offer is not a waiver of the Department's right of immediate termination.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The PACE Organization Provider Agreement may be terminated by either the Department or the PACE provider if the other party fails to meet a provision of:</text>
      <paragraph num="(a)">
        <text>This chapter;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The PACE Organization Provider Agreement; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Applicable laws, rules, regulations, or guidelines effective as of the date of the PACE Organization Provider Agreement or enacted or established during the PACE Organization Provider Agreement's term.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>A PACE Organization Provider Agreement's termination is effective only after the terminating party has notified the breaching party in writing of the cause or causes of termination and has allowed 60 days for the correction or alleviation of the cause or causes by the breaching party.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Termination of Agreement by PACE. The PACE provider may terminate an agreement after timely notice to CMS, the Department, and PACE participants, as follows:</text>
      <paragraph num="(a)">
        <text>To CMS and the Department, 90 days before termination; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>To PACE participants, 60 days before termination.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Default by PACE.</text>
    <paragraph num="(1)">
      <text>The Department may immediately terminate the PACE Organization Provider Agreement if the PACE provider defaults, as specified in §D(3) of this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the PACE provider defaults, the Department may recover any capitation payments issued to the PACE provider for periods after the termination effective date of the PACE Organization Provider Agreement.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The following are defaults by the PACE provider:</text>
      <paragraph num="(a)">
        <text>Inability to provide the services described in the PACE provider benefit package and in Regulation .09 of this chapter; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Insolvency.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Nonexclusivity of Remedy.</text>
    <paragraph num="(1)">
      <text>This regulation's provisions supplement, rather than replace, any other sanctions or remedies available to the Department under the provisions of Regulation .24 of this chapter, the PACE Organization Provider Agreement, the Medicaid Provider Agreement, or applicable law or regulations.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>If the PACE Program Provider Agreement is terminated under this regulation, the PACE provider shall furnish to the Department, within 45 days of the termination's effective date, all information necessary for the reimbursement of any outstanding claims for services rendered to the PACE provider's participants, including claims of its contractors.</text>
    </paragraph>
  </paragraph>
</regulation>