Information Collection Request

The PACE Organization (PO) Monitoring and Audit Process in Part 460 of 42 CFR (CMS-10630)

ICR 202507-0938-006 · OMB 0938-1327 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10630 Request for Additional Information (RAI)/PO Response Form and Instruction Modified Available
Form CMS-10630 CAP Template Form and Instruction Modified Available
Form CMS-10630 Service Determination Request (SDR) Cover Sheet Form Modified Available
Form CMS-10630 RequiredSpecialistContracts Form and Instruction Modified Repair queued
Form CMS-10630 Plan of Care Form and Instruction Modified Available
Form CMS10630 Participant Rights Form and Instruction Modified Repair queued
Form CMS-10630 Grievance Recognition and Notification Form and Instruction Modified Repair queued
Form CMS-10630 Arranging Services Form and Instruction Modified Available
Form CMS-10630 Appeals Effectuation Form and Instruction Modified Repair queued
Form CMS-10630 Appeal Recognition Form and Instruction Modified Repair queued
Form CMS-10630 Special Recommendations Form and Instruction Modified Available
Form CMS-10630 Required Services Form and Instruction Modified Repair queued
Form CMS-10630 Coordination of Care Form Modified Available
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form Modified Repair queued
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form Modified Available
Form CMS-10630 Service Delivery Request Impact Analysis Template Form Modified Available
Form CMS-10630 Service Delivery Request Impact Analysis Template Form Modified Available
Form CMS-10630 Root Cause Analysis Template Form Modified Available
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form Modified Available
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form and Instruction Modified Available
Form CMS-10630 Personnel Impact Analysis Template Form and Instruction Modified Repair queued
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form and Instruction Modified Available
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form Modified Available
Form CMS-10630 Grievances Impact Analysis Template Form Modified Repair queued
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form and Instruction Modified Repair queued
Form CMS-10630 Service Delivery Request and Appeals Impact Analysis Template Form Modified Repair queued
Form CMS-10630 Audit Survey Form and Instruction Modified Available
Form CMS-10630 Corrective Action Plan (CAP) Process Form Modified Available
Form CMS-10630 PACE Audit Process and Data Request Protocol Form and Instruction Modified Available
Form CMS-10630 PACE Supplemental Questionnaire Form Modified Available
Form CMS-10630 Summary of any pre-audit issues Form Modified Repair queued
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form Modified Available
Form CMS-10630 Appeals Impact Analysis Template Form Modified Available
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template Form Modified Repair queued
Form CMS-10630 Trial Year and Routine Audits Form Modified Repair queued
CMS10630_CrosswalkofChanges_Final.pdf Supplementary Document Uploaded 2026-02-11 Repair queued
CMS-10630_ResponseToComments_30-day.pdf Supplementary Document Uploaded 2026-02-11 Repair queued
2025_NPA_CMS_2026 Audit Protocol_30-Day Comment Letter_SMB-Signed.pdf Public Comments Uploaded 2025-08-13 Available
PC_202507-0938-006_081325_050357_1.pdf Public Comments Uploaded 2025-08-13 Available
PC_202507-0938-006_081225_125903_1.pdf Public Comments Uploaded 2025-08-12 Available
Comments Template_PACE 2026 Audit Protocol - 30 Day_Final.pdf Public Comments Uploaded 2025-08-04 Available
PC_202507-0938-006_080425_074240_1.pdf Public Comments Uploaded 2025-08-04 Available
CMS10630-SupportingStatement_Final Clean.docx Supporting Statement A Uploaded 2026-02-11 Repair queued
CMS10630-SupportingStatement_A.docx Supporting Statement A Uploaded 2025-07-14 Repair queued
PACE Southeast Michigan.pdf Public Comments Uploaded 2025-02-20 Repair queued
On Lok Senior Health Services - On Lok.pdf Public Comments Uploaded 2025-02-21 Available
National PACE Association NPA.pdf Public Comments Uploaded 2025-02-20 Available
myPlace PACE.pdf Public Comments Uploaded 2025-02-18 Available
MultiCare Health System.pdf Public Comments Uploaded 2025-02-20 Repair queued
Habitat Health.pdf Public Comments Uploaded 2025-02-19 Available
Aging and Long-Term Support Administration ALTSA.pdf Public Comments Uploaded 2025-02-18 Available
CMS10630_CrosswalkofChanges_30-day.pdf Supplementary Document Uploaded 2025-07-07 Repair queued
CMS10630_CrosswalkofChanges_30-day.pdf Supplementary Document Uploaded 2025-07-07 Repair queued
CMS-10630_ResponseToComments_60-day.pdf Supplementary Document Uploaded 2025-07-07 Available
CMS-10630_ResponseToComments_60-day.pdf Supplementary Document Uploaded 2025-07-07 Missing upstream
CMS10630_CrosswalkofChanges_2026_60-day.pdf Supplementary Document Uploaded 2025-07-07 Repair queued
CMS10630_CrosswalkofChanges_2026_60-day.pdf Supplementary Document Uploaded 2025-07-07 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
225129 Trial Year and Routine Audits Form and Instruction ModifiedRequest for Additional Information (RAI)/PO Response
225129 Trial Year and Routine Audits Form and Instruction ModifiedCAP Template
225129 Trial Year and Routine Audits Form ModifiedService Determination Request (SDR) Cover Sheet
225129 Trial Year and Routine Audits Form and Instruction ModifiedRequiredSpecialistContracts
225129 Trial Year and Routine Audits Form and Instruction ModifiedPlan of Care
225129 Trial Year and Routine Audits Form and Instruction ModifiedParticipant Rights
225129 Trial Year and Routine Audits Form and Instruction ModifiedGrievance Recognition and Notification
225129 Trial Year and Routine Audits Form and Instruction ModifiedArranging Services
225129 Trial Year and Routine Audits Form and Instruction ModifiedAppeals Effectuation
225129 Trial Year and Routine Audits Form and Instruction ModifiedAppeal Recognition
225129 Trial Year and Routine Audits Form and Instruction ModifiedSpecial Recommendations
225129 Trial Year and Routine Audits Form and Instruction ModifiedRequired Services
225129 Trial Year and Routine Audits Form ModifiedCoordination of Care
225129 Trial Year and Routine Audits Form ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedService Delivery Request Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedService Delivery Request Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedRoot Cause Analysis Template
225129 Trial Year and Routine Audits Form ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form and Instruction ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form and Instruction ModifiedPersonnel Impact Analysis Template
225129 Trial Year and Routine Audits Form and Instruction ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedGrievances Impact Analysis Template
225129 Trial Year and Routine Audits Form and Instruction ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedService Delivery Request and Appeals Impact Analysis Template
225129 Trial Year and Routine Audits Form and Instruction ModifiedAudit Survey
225129 Trial Year and Routine Audits Form ModifiedCorrective Action Plan (CAP) Process
225129 Trial Year and Routine Audits Form and Instruction ModifiedPACE Audit Process and Data Request Protocol
225129 Trial Year and Routine Audits Form ModifiedPACE Supplemental Questionnaire
225129 Trial Year and Routine Audits Form ModifiedSummary of any pre-audit issues
225129 Trial Year and Routine Audits Form ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedAppeals Impact Analysis Template
225129 Trial Year and Routine Audits Form ModifiedClinical Appropriateness and Care Planning Impact Analysis Template
225129 Trial Year and Routine Audits Form Modified
ICR Details
0938-1327 202507-0938-006
Active 202205-0938-008
HHS/CMS CM-CPC
The PACE Organization (PO) Monitoring and Audit Process in Part 460 of 42 CFR (CMS-10630)
Revision of a currently approved collection   No
Regular
Approved with change 02/12/2026
Retrieve Notice of Action (NOA) 07/16/2025
  Inventory as of this Action Requested Previously Approved
02/28/2029 36 Months From Approved 02/28/2026
40 0 40
26,840 0 31,200
0 0 0

42 CFR 460.190 and 460.192 described CMS’s regulatory authority to monitor, through audit or other means, the Programs for All-Inclusive Care of the Elderly (PACE). This monitoring includes review of books, contracts, medical records, patient care documentation and any other records that pertain to any aspect of services performed, reconciliation of benefit liabilities, and determination of amounts payable. CMS developed a strategy to address our oversight and audit responsibilities. We have combined both the trial year and ongoing audit protocols into one universal audit protocol that is streamlined and outcomes based to reduce the financial and administrative burdens for both CMS and PACE organizations.

US Code: 42 USC 1395eee Name of Law: Social Security Act
   US Code: 42 USC 1396u–4 Name of Law: Social Security Act
  
None

Not associated with rulemaking

  89 FR 104545 12/23/2024
90 FR 31209 07/14/2025
Yes

1
IC Title Form No. Form Name
Trial Year and Routine Audits CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630, CMS10630, CMS-10630, CMS-10630, CMS-10630, CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis Template ,   Appeals Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Summary of any pre-audit issues ,   PACE Supplemental Questionnaire ,   PACE Audit Process and Data Request Protocol ,   Corrective Action Plan (CAP) Process ,   Audit Survey ,   Service Delivery Request and Appeals Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Grievances Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Personnel Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Root Cause Analysis Template ,   Service Delivery Request Impact Analysis Template ,   Service Delivery Request Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Clinical Appropriateness and Care Planning Impact Analysis Template ,   Coordination of Care ,   Required Services ,   Special Recommendations ,   Appeal Recognition ,   Appeals Effectuation ,   Arranging Services ,   Grievance Recognition and Notification ,   Participant Rights ,   Plan of Care ,   RequiredSpecialistContracts ,   Service Determination Request (SDR) Cover Sheet ,   CAP Template ,   Request for Additional Information (RAI)/PO Response

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 40 40 0 0 0 0
Annual Time Burden (Hours) 26,840 31,200 0 -4,360 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
CMS estimates that the total burden associated with the 2026 protocol is reduced to 671 hours per PACE organization. This was burden decrease was completed due to comment feedback to meaningfully decrease respondent time and effort to prepare, review and submit collection instruments.

$14,706,560
No
    No
    No
No
No
No
No
Stephan McKenzie 410 786-1943 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/16/2025