Programs of All-Inclusive Care for the 
Elderly (PACE) 
 
Chapter 5  Participant Rights and Restraint Policies 
Table of Contents 
(Rev. 2, Issued: 06-09-11) 
 
Transmittals for Chapter 5 
 
10 - Participant Bill of Rights 
 
20 - Specific Rights to which a Participant is Entitled 
 
20.1 - Right #1 - Respect and Nondiscrimination 
 
20.2 - Right #2 - Information Disclosure 
 
20.3 - Right #3 - Choice of Providers 
 
20.4 - Primary Care Physician 
 
20.5 - Informing Female Participants 
 
20.6 - Right #4 - Access to Emergency Services 
 
20.7 - Right #5 - Participation in Treatment Decisions 
 
20.8 - Right #6 - Confidentiality of Health Information 
 
20.9 - Right #7 - Complaints and Appeals 
 
30 - Restraints 
  10 - Participant Bill of Rights 
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
The PACE organization is required to have a written participant Bill of Rights designed 
to protect and promote the rights of each participant. Those rights include; at a minimum, 
those specified in 42 CFR  460.112. 
 
The PACE organization must inform a participant upon enrollment, in writing, of his or 
her rights and responsibilities, and all rules and regulations governing participation. This 
should include: 
 
  Written policies: A PACE organization must have written policies and 
implement procedures to ensure that the participant, his or her representative, 
if any, and staff understand these rights; 
 
  Explanation of rights: The PACE organization must fully explain the rights to 
the participant and his or her representative, if any, at the time of enrollment 
in a manner understood by the participant; 
 
  The participants rights must be available in writing in English and in any 
other principal languages of the community; 
 
  The participant rights must be displayed in a prominent place within the 
PACE center. 
 
The PACE organization must protect and provide for the exercise of the participants 
rights. The PACE organization must have established documented procedures to respond 
to and rectify a violation of a participants rights. A template for the Bill of Rights may 
be obtained from the following 
link http://www.cms.hhs.gov/PACE/Downloads/participantrights.pdf. 
 
[42 CFR 460.116] 
 
20 - Specific Rights to which a Participant is Entitled 
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
20.1 - Right #1 - Respect and Nondiscrimination  
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
Each participant has the right to considerate, respectful care from all PACE employees 
and contractors at all times and under all circumstances. Each participant has the right not 
to be discriminated against in the delivery of required PACE services based on race, 
ethnicity, national origin, religion, sex, age, sexual orientation, mental or physical 
disability, or source of payment. 
 
Specifically, each PACE participant has the right to the following:   
  To receive comprehensive health care in a safe and clean environment and in 
an accessible manner; 
 
  To be treated with dignity and respect, be afforded privacy and confidentiality 
in all aspects of care, and to be provided humane care; 
 
  Not to be required to perform services for the PACE organization; 
 
  To have reasonable access to a telephone; 
 
  To be free from harm, including physical or mental abuse, neglect, corporal 
punishment, involuntary seclusion, excessive medication, and any physical or 
chemical restraint imposed for purposes of discipline or convenience and not 
required to treat the participants medical symptoms; 
 
  To be encouraged and assisted to exercise rights as a participant, including the 
Medicare and Medicaid appeals processes as well as civil and other legal 
rights; 
 
  To be encouraged and assisted to recommend changes in policies and services 
to PACE staff. 
 
[42 CFR  460.112(a)] 
 
20.2 - Right #2 - Information Disclosure 
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
Each PACE participant (or the designated representative of the participant) has the right 
to receive accurate, easily understood information and to receive assistance in making 
informed health care decisions. 
 
Specifically, each participant has the following rights: 
 
  To be fully informed, in writing, of the services available from the PACE 
organization, including identification of all services that are delivered through 
contracts, rather than furnished, directly by the PACE organization at the 
following times: 
 
  Before enrollment; 
 
  At enrollment; and 
 
  At the time a participants needs necessitate the disclosure and delivery of 
such information in order to allow the participant to make an informed 
choice;   
  To have the enrollment agreement, described in 42 CFR  460.154, fully 
explained in a manner understood by the participant; 
 
  To examine, or upon reasonable request, to be assisted to examine the results 
of the most recent review of the PACE organization conducted by CMS or the 
State Administering Agency and any plan of correction in effect. 
 
[42 CFR  460.112(b)] 
 
20.3 - Right #3 - Choice of Providers  
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
Each participant has the right to a choice of health care providers, within the PACE 
organizations network, that is sufficient to ensure access to appropriate high-quality 
health care. 
 
Specifically, each participant has the right to the following: 
 
  To choose his or her primary care physician and specialists from within the 
PACE network; 
 
  To disenroll from the program at any time; 
 
  To request that a qualified specialist for womens health services provide 
routine or preventive womens health services. The PACE organization must: 
 
  Provide access to all specialties within its network and explain to 
participants that they are required to receive all services through the PACE 
organization; 
 
  Give participants the choice of providers as well as communicate the right 
of female participants to choose a qualified specialist in womans health; 
 
  Contract, when possible, with more than one provider of gynecological 
services. 
 
[42 CFR  460.112(c); 71 FR 71291 (Dec. 8, 2006)] 
 
20.4 - Primary Care Physician 
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
A Primary Care Physician (PCP) is qualified to perform primary care including basic 
Gynecological (GYN) services, but the PCP is not a qualified specialist for womens 
health services. Although female participants may choose their PCP for basic GYN 
services, if a participant requests a GYN specialist or the participant requires more  complex GYN services, the participant must be provided a GYN specialist and, when 
possible, be provided a choice of GYN specialists. 
 
[71 FR 71291 (Dec. 8, 2006)] 
 
20.5 - Informing Female Participants 
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
The Interdisciplinary Team (IDT) physician or alternative IDT member identified in the 
organizations care planning policy must inform female participants that they are entitled 
to choose a qualified specialist for womens health services to provide routine or 
preventive womens health services from the PACE organizations network. In some 
PACE organizations, the physician makes this notification during intake, the enrollment 
process, or at the initial physician assessment. If notification has not been made prior to 
development of the care plan, 42 CFR  460.104(b) requires the IDT team to make this 
notification during the care plan development or when the proposed care plan is 
subsequently presented to the participant and/or care giver for discussion, revision, and 
incorporation of the participants preferences. 
 
[42 CFR  460.104(b); 71 FR 71296 (Dec. 8, 2006)] 
 
20.6 - Right #4 - Access to Emergency Services  
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
Each participant has the right to access emergency health care services when and where 
the need arises without prior authorization by the PACE IDT. 
 
[42 CFR  460.112(d)] 
 
20.7 - Right #5 - Participation in Treatment Decisions  
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
Each participant has the right to participate fully in all decisions related to his or her 
treatment. A participant who is unable to participate fully in treatment decisions has the 
right to designate a representative. 
 
Specifically, each participant has the right: 
 
  To have all treatment options explained in a culturally competent manner and 
to make health care decisions, including the right to refuse treatment, and be 
informed of the consequences of the decisions; 
 
  To have the PACE organization explain advance directives and to establish 
them, if the participant so desires, in accordance with 42 CFR  489.100 and 
489.102; 
    To be fully informed of his or her health and functional status by the 
interdisciplinary team; 
 
  To participate in the development and implementation of the plan of care; 
 
  To request a reassessment by the interdisciplinary team; 
 
  To be given reasonable advance notice, in writing, of any transfer to another 
treatment setting and the justification for the transfer (that is, due to medical 
reasons or for the participants welfare, or that of other participants). The 
PACE organization must document the justification in the participants 
medical record. 
 
[42 CFR  460.112(e)] 
 
20.8 - Right #6 - Confidentiality of Health Information  
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
Each participant has the right to communicate with health care providers in confidence 
and to have the confidentiality of his or her individually identifiable health care and other 
information protected. Each participant also has the right to review and copy his or her 
own medical records and request amendments to those records. 
 
Specifically, each participant has the following rights: 
 
  To be assured of confidential treatment of all information contained in the 
health record, including information contained in an automated data bank; 
 
  To be assured that his or her written consent will be obtained for the release of 
information to persons not otherwise authorized under law to receive it; 
 
  To provide written consent that limits the degree of information and the 
persons to whom information may be given. 
 
[42 CFR  460.112(f)] 
 
20.9 - Right #7 - Complaints and Appeals  
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
Each participant has the right to a fair and efficient process for resolving differences with 
the PACE organization, including a rigorous system for internal review by the 
organization and an independent system of external review. 
 
Specifically, each participant has the following rights: 
    To be encouraged and assisted to voice complaints to PACE staff and outside 
representatives of his or her choice, free of any restraint, interference, 
coercion, discrimination, or reprisal by the PACE staff; 
 
  To appeal any treatment decision of the PACE organization, its employees, or 
contractors through the process described in 42 CFR  460.122. 
 
[42 CFR  460.112(g)] 
 
30 - Restraints 
(Rev. 2, Issued: 06-09-11; Effective: 06-03-11; Implementation: 06-03-11) 
 
The use of restraints must be based on the assessed needs of the participant, be monitored 
and reassessed appropriately, and be ordered for a defined and limited period of time. The 
least restrictive and most effective method available must be utilized and it must conform 
to the participants plan of care. Restraints may only be used as a last resort and must be 
removed or ended at the earliest possible time. Restraints of any kind should never be 
used as a preferred approach to care and PACE organizations are expected to ensure that 
their programs are restraint free to the greatest extent possible. 
 
The term restraint includes physical or chemical restraints. A physical restraint is any 
manual method or physical or mechanical device, materials, or equipment attached or 
adjacent to the participants body that he or she cannot easily remove and that restricts 
freedom of movement or normal access to ones body. A chemical restraint is a 
medication used to control behavior or to restrict the participants freedom of movement, 
and that is not a standard treatment for the participants medical or psychiatric condition. 
 
If the IDT determines that a restraint is needed to ensure the participants physical safety 
or the safety of others, the use must meet the following conditions: 
 
  Be imposed for a defined, limited period of time, based upon the assessed 
needs of the participant; 
 
  Be imposed in accordance with safe and appropriate restraining techniques; 
 
  Be imposed only when other less restrictive measures have been found to be 
ineffective to protect the participant or others from harm; 
 
  Be removed or ended at the earliest possible time. 
 
A PACE organization must have policies and procedures regarding restraints that: 
 
  Define physical and chemical restraints as described above; 
 
  Include the conditions on use described above; 
    Describe how personnel will continually assess, monitor and reevaluate 
(specify time intervals) the participants condition while in restraints. 
 
[42 CFR  460.114; 71 FR 71299 (Dec. 8, 2006)]  Transmittals Issued for this Chapter 
 
Rev #  Issue Date  Subject  Impl Date  CR# 
R2PACE 06/09/2011  Initial Publication of Manual  06/03/2011 NA 
06/03/2011  Initial Publication of Manual - Rescinded and  06/03/2011 NA 
R1_SO 
replaced by Transmittal 2 
 
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