OMB control number

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

OMB 0938-1327 · HHS/CMS.

OMB 0938-1327

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.

The latest form for The PACE Organization (PO) Monitoring and Audit Process in Part 460 of 42 CFR (CMS-10630) expires 2029-02-28 and is listed under ICR 202507-0938-006.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CMS-10630 Request for Additional Information (RAI)/PO ResponseForm and Instruction
Form CMS-10630 CAP TemplateForm and Instruction
Form CMS-10630 Service Determination Request (SDR) Cover SheetForm
Form CMS-10630 RequiredSpecialistContractsForm and Instruction
Form CMS-10630 Plan of CareForm and Instruction
Form CMS10630 Participant RightsForm and Instruction
Form CMS-10630 Grievance Recognition and NotificationForm and Instruction
Form CMS-10630 Arranging ServicesForm and Instruction
Form CMS-10630 Appeals EffectuationForm and Instruction
Form CMS-10630 Appeal RecognitionForm and Instruction
Form CMS-10630 Special RecommendationsForm and Instruction
Form CMS-10630 Required ServicesForm and Instruction
Form CMS-10630 Coordination of CareForm
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm
Form CMS-10630 Service Delivery Request Impact Analysis TemplateForm
Form CMS-10630 Service Delivery Request Impact Analysis TemplateForm
Form CMS-10630 Root Cause Analysis TemplateForm
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm and Instruction
Form CMS-10630 Personnel Impact Analysis TemplateForm and Instruction
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm and Instruction
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm
Form CMS-10630 Grievances Impact Analysis TemplateForm
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm and Instruction
Form CMS-10630 Service Delivery Request and Appeals Impact Analysis TemplateForm
Form CMS-10630 Audit SurveyForm and Instruction
Form CMS-10630 Corrective Action Plan (CAP) ProcessForm
Form CMS-10630 PACE Audit Process and Data Request ProtocolForm and Instruction
Form CMS-10630 PACE Supplemental QuestionnaireForm
Form CMS-10630 Summary of any pre-audit issuesForm
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm
Form CMS-10630 Appeals Impact Analysis TemplateForm
Form CMS-10630 Clinical Appropriateness and Care Planning Impact Analysis TemplateForm
Form CMS-10630 Trial Year and Routine AuditsForm
CMS10630_CrosswalkofChanges_Final.pdfSupplementary Document
CMS-10630_ResponseToComments_30-day.pdfSupplementary Document
2025_NPA_CMS_2026 Audit Protocol_30-Day Comment Letter_SMB-Signed.pdfPublic Comments
PC_202507-0938-006_081325_050357_1.pdfPublic Comments
PC_202507-0938-006_081225_125903_1.pdf (document unavailable)Public Comments
Comments Template_PACE 2026 Audit Protocol - 30 Day_Final.pdfPublic Comments
PC_202507-0938-006_080425_074240_1.pdfPublic Comments
CMS10630-SupportingStatement_Final Clean.docxSupporting Statement A
CMS10630-SupportingStatement_A.docxSupporting Statement A
PACE Southeast Michigan.pdf (document unavailable)Public Comments
On Lok Senior Health Services - On Lok.pdfPublic Comments
National PACE Association NPA.pdfPublic Comments
myPlace PACE.pdfPublic Comments
MultiCare Health System.pdf (document unavailable)Public Comments
Habitat Health.pdfPublic Comments
Aging and Long-Term Support Administration ALTSA.pdfPublic Comments
CMS10630_CrosswalkofChanges_30-day.pdfSupplementary Document
CMS-10630_ResponseToComments_60-day.pdfSupplementary Document
CMS-10630_ResponseToComments_60-day.pdf Supplementary Document
CMS10630_CrosswalkofChanges_2026_60-day.pdfSupplementary Document
CMS10630_CrosswalkofChanges_2026_60-day.pdf Supplementary Document
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form and Instruction
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form
Trial Year and Routine Audits Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202507-0938-006 Revision of a currently approved collection 2025-07-16
202205-0938-008 Revision of a currently approved collection 2022-05-10 Approved without change
201911-0938-013 Revision of a currently approved collection 2019-12-04 Approved with change
201612-0938-020 New collection (Request for a new OMB Control Number) 2017-01-12 Approved with change