Central Valley PACE is a PACE Medicare Health Plan and a Part D Prescription Drug Plan. As such, PACE must adhere to CMS requirements of a Medicare Health Plan with few exceptions. Central Valley PACE is also a department of Golden Valley Health Centers. Each share the same mission and goals. The Central Valley PACE Compliance and Fraud Waste and Abuse Program describes the plan to ensure compliance with CMS requirements. Part of that plan is to ensure partnering entities of Central Valley PACE adhere to CMS compliance requirements.
As a Medicare Health Plan, Central Valley PACE partners with individuals and organizations in support of providing the most robust and efficient services. Partnering entities are referred to as First Tier, Downstream and Related Entities by CMS. Partnerships are defined through contractual arrangements. It is the responsibility of Central Valley PACE to ensure that its contracting partners are committed to CMS compliance fulfillment including:
- Reducing fraud, waste and abuse (FWA)
- Complying with laws and regulations
- Implementing compliance policies
Compliance Fulfillment refers to adherence to CMS compliance and fraud waste and abuse (FWA) requirements found in Chapter 21 of the Medicare Managed Care Manual and Chapter 9 of the Prescription Drug Benefit Manual. These manuals reference the Code of Federal Regulations describing FDR compliance and FWA requirements. These requirements are discussed in the FDR Compliance Guide. It is the responsibility of the Medicare Health Plan to ensure First Tier Entities and their downstream contractors adhere to referenced CMS regulations. Please take the time to read the following information: