OMB control number
PACE State Plan Amendment Pre-print (CMS-10227)
OMB 0938-1027 ยท HHS/CMS.
OMB 0938-1027
The Balanced Budget Act of 1997 created Section 1934 of the Social Security Act that established the Program for the All-Inclusive Care for the Elderly (PACE). The legislation established the PACE program as a Medicaid State plan option serving the frail and elderly in the home and community. Pursuant to the notice given in 64 FR 66271 (November 24, 199), if a State elects to offer PACE as an optional Medicaid benefit, it must complete a State Plan Amendment described as Enclosures 3, 4, 5, 6 and 7. The information, collected by CMS on a one-time basis, is used by CMS to affirm that the State elects to offer PACE as an optional State plan service and the specifications of eligibility, payment and enrollment for the program.
The latest form for PACE State Plan Amendment Pre-print (CMS-10227) expires 2026-06-30 and is listed under ICR 202301-0938-020.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 CMS-10227 - Supporting Statement A (2022 version 4).docx (document unavailable) | Supporting Statement A |
 PACE State Plan Option Preprint (CMS-10227) |
Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202301-0938-020 | Extension without change of a currently approved collection | 2023-02-10 | Approved without change | |
| 202001-0938-017 | Revision of a currently approved collection | 2020-05-18 | Approved without change | |
| 201702-0938-007 | Extension without change of a currently approved collection | 2017-02-23 | Approved with change | |
| 201312-0938-012 | Extension without change of a currently approved collection | 2013-12-19 | Approved without change | |
| 201011-0938-015 | Extension without change of a currently approved collection | 2010-11-29 | Approved without change | |
| 200709-0938-001 | Existing collection in use without an OMB Control Number | 2007-09-10 | Approved without change |