Programs of All-Inclusive Care for the 
Elderly (PACE)
Chapter 3  Marketing Guidelines
Rev. 5, Issued:  10/2/2018
10  Introduction 
The PACE Marketing Guidelines (PMG) interpret and provide guidance on 
marketing requirements and related provisions of the Programs of All-
Inclusive Care for the Elderly (PACE) rules (Chapter 42 of the Code of 
Federal Regulations (CFR), Part 460 (See Appendix 1 for a list of related 
laws and regulations). PACE Organizations (PO) must follow all Federal laws 
and regulations that impact marketing including, but not limited to those 
listed in Appendix 1. POs also must comply with any State specific 
requirements. POs must ensure the activities of all subcontractors, 
downstream entities, and/or delegated entities are compliant with all 
aforementioned laws and regulations. 
POs should direct questions regarding a marketing material or practice that 
is not addressed in this guidance to their CMS Account Manager (AM).  
POs may not begin marketing until their initial application has been 
approved, and they have received their signed PACE program agreement. 
Additionally, POs may not market new PACE centers or service areas until 
they receive their amended, signed program agreement.  
20  Required Information to Be Conveyed Through Marketing 
Materials 
42 CFR 460.82(a)(1) 
20.1 PACE Program Information 
The following information must be included in marketing materials provided 
to prospective participants, prior to an enrollment decision:  
 An adequate description of the POs enrollment and disenrollment
policies and requirements;
 PACE enrollment procedures;
Note: Additional information on enrollment and disenrollment is
available in the PACE Manual at http://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-
Items/CMS019036.html
 Description of benefits and services;   Premiums; e.g.,  
  What you pay for PACE depends on your eligibility under 
Medicare and Medicaid. 
  If you are eligible for Medicaid, or dually eligible for both 
Medicare and Medicaid, you won't pay a monthly premium for 
PACE. 
  If you don't qualify for Medicaid, but you have Medicare, you'll 
be charged a monthly premium for PACE. 
  There's no deductible or copayment for any drug, service, or 
care approved by your health care team. 
  If you don't have Medicare or Medicaid, you can pay for PACE 
privately. 
  Other information necessary for prospective participants to make an 
informed decision about enrollment. 
Note: POs do not have to include all of the information outlined in 
section 20 in all marketing materials; rather the PO must ensure that 
the aggregate of materials received by a prospective participant 
contains the required information.  
20.2  Information on the Restriction of Services 
42 CFR 460.82(d)(1) 
  
Marketing materials must inform a prospective PACE participant that they 
must receive all needed health care services, including primary care and 
specialist physician services (other than emergency services), from the PO 
or an entity authorized by the PO.  
20.3  Liability for Costs  
42 CFR 460.82(d)(2) 
All marketing materials must state clearly that PACE participants may be 
fully and personally liable for the costs of unauthorized or out-of-PACE 
program agreement services. 
     
30  Marketing Material Identification, Submission, and Review 
Process 
30.1  The Marketing Review Process 
The PACE Marketing Module in HPMS is an automated tool used to enter, 
track, and maintain marketing materials submitted for review and approval. 
POs must submit marketing materials subject to CMS review in HPMS. This 
includes materials associated with PACE initial or service area expansion 
(SAE) applications, and materials created and used by subcontractors on the 
POs behalf.  
The HPMS module facilitates dual reviews by the CMS Regional Office and 
the state. Except where otherwise noted, marketing materials must be 
reviewed and approved by CMS and the state prior to their use by the PO.  
30.2  PO Responsibilities  
42 CFR 460.82(b) 
Prior to submission, the PO should ensure all marketing materials are in 
accordance with the requirements of this guidance and other CMS and state 
issued guidance and instructions. CMS does not review marketing materials 
for typographical or grammatical errors, unless such errors render the 
materials inaccurate or misleading. 
30.3  Marketing Material Identification 
42 CFR 460.82(b) 
 
POs must place a unique marketing material identification (ID) number on all 
marketing materials (except as indicated below) to facilitate CMS review and 
oversight. 
The marketing material ID includes:  (1) PO contract number (i.e., HXXXX), 
and (2) any series of alpha numeric characters chosen by the PO.  
The following marketing materials do not require a marketing material ID: 
  ID cards;  
  Radio ads; and 
  social media comments and posts  30.3.1  Marketing Material Identification Number for Non-English or 
Alternate Format Materials 
42 CFR 460.82(b) 
 
Non-English or alternate format materials must be given a unique material 
ID using the method outlined above. When submitting these materials in 
HPMS, POs must designate that they are non-English or alternate format 
versions. See section 30.4.2 for additional information about the submission 
of non-English and alternate format materials. 
30.4  Material Submission Process  
42 CFR 460.82(b) 
POs must select a CMS and state reviewer when submitting materials for 
review. POs should refer to the HPMS Marketing Module User Guide for 
instructions on how to submit materials in HPMS.  
Note: Under certain circumstances, and with prior CMS approval, 
materials may be submitted outside of HPMS. 
30.4.1  Submission of Marketing Materials Associated with an Application 
42 CFR 460.82(b)(2) 
Materials submitted as a part of an initial or a SAE application must: 
  Be submitted within 5 days of the application submission; and 
  Include the contract number and Initial Application or SAE 
Application in the comments field of the marketing submission (for 
example: H1234 Initial Application).  
 
30.4.2  Submission of Non-English and Alternate Format Materials  
42 CFR 460.82(b), 460.82(c) 
Non-English and alternate format material must either be based on 
previously approved English/standard print versions of the same material, or 
include an English translation with the non-English/alternate format material 
submission. Both non-English and alternate format materials should be 
submitted as alternate format materials in HPMS. If the alternate format 
cannot be submitted in HPMS (e.g., braille), the PO should contact its AM 
and/or the state point of contact to discuss a different method for 
submission.   Note: POs do not need to submit large-print materials as an alternate 
format material in HPMS if the only modification to the material is an 
increased font size and/or layout changes due to the increased font 
size.  
Multi-lingual is defined as material that incorporates English and another 
language(s). POs should include a note in the HPMS comments field 
specifying that the material is multi-lingual. Multi-lingual material should not 
be submitted as an alternate format material.  
Any revisions that are made to the original English versions of materials 
should also be made to the non-English and alternate format versions and 
re-submitted in HPMS.  
Note: See Appendix 1 for a definition of alternate formats.  
30.4.3  Submission of Websites for Review  
42 CFR 460.82(b) 
Website content, other than content that would fall under section 80 of this 
guidance, must be submitted for review in HPMS. POs should submit a 
document that includes a link(s) to any PO website(s) so that CMS may 
review the information as it appears on the live or test website. POs may 
submit screen shots in lieu of a live website.  
The PO should submit updated pages of their website in HPMS for CMS and 
state approval. POs must submit links to the updated pages in HPMS and 
include their own material ID and date stamp.  
POs that have been approved to operate may make their website publicly 
available during the CMS review period; however, POs must indicate that the 
website is pending CMS review until CMS has either approved or disapproved 
the website. If the website, or portions of the website, are disapproved, POs 
must submit their revised website to CMS within 20 calendar days, or they 
must remove the disapproved content from public view. POs may not post 
websites for new PACE centers or service areas until they have received their 
amended, signed program agreement.  
     
30.5  Timeframes for Marketing Review  
42 CFR 460.82(b)(3)(i) 
Marketing materials will be reviewed within 45 calendar days of submission. 
The 45 day period begins on the date of submission in HPMS. Materials that 
have been submitted, but not reviewed within the 45-day time frame, are 
deemed approved.  
 
Note: Materials associated with an application will be reviewed within 
45 days or prior to the due date of the application, whichever comes 
firsts. 
   
30.6  HPMS Material Statuses  
42 CFR 460.82(b) 
Once reviewed, all marketing materials in HPMS will have an indication of 
their status, as: approved, disapproved, withdrawn, alternate format, or 
deemed.  
Note: If a PO does not have a signed program agreement, all 
submitted and approved marketing materials will be considered 
conditionally approved, meaning that the material is approved once 
the PO receives a signed PACE program agreement. A PO may not 
market until it has received a signed program agreement. 
30.6.1  Approved  
42 CFR 460.82(b) 
Materials marked approved may be used in the format in which they were 
submitted. CMS retains the right to disapprove previously approved 
marketing materials if they are subsequently found to be inaccurate, altered, 
or otherwise non-compliant.  
30.6.2  Disapproved  
42 CFR 460.82(b) 
Materials marked disapproved may not be used. A reason for the 
disapproval will be included in HPMS.   30.6.3  Withdrawn  
42 CFR 460.82(b) 
POs may withdraw a marketing material following submission and review.   
POs should submit a written request to their AM stating the reason(s) for the 
withdrawal.  
30.6.4  Alternate Format  
42 CFR 460.82(b) 
Non-English and alternate format materials will be marked as Alternate 
Format and are not reviewed or given an approval designation by CMS 
because they are based on previously approved materials.   
30.6.5  Deemed 
42 CFR 460.82(b) 
Materials that are submitted, but not reviewed by CMS within 45 days are 
deemed approved. The status of deemed will be notated on the 46th day. 
Materials marked as deemed may be used in the format in which they 
were submitted.   
30.6.6  Resubmitting Previously Disapproved Materials 
42 CFR 460.82(b)   
POs may modify and resubmit previously disapproved materials. POs should 
highlight changes and/or insert notes regarding all modifications in the 
comments section of HPMS. Please see the HPMS Marketing Module User 
Guide for additional information.  
30.6.7  Template Materials  
42 CFR 460.82(b) 
A template includes placeholders for variable data that may be populated by 
a PO. Templates allow POs to submit one master document with variable 
elements tailored to one or multiple PACE centers. Variable elements may 
include the PO name, address, telephone number, and/or URL. 
POs must submit templates in HPMS and indicate how the variable data will 
be populated.  POs should insert the name of the field using brackets (e.g. 
[PO name]), or by populate the fields with all variables (e.g., [PO name 
Center A, PO name Center B, PO name Center C]). Template Materials will  have only one marketing ID number regardless of the number and 
combination of variables. 
40  Accessibility and Formatting Requirements 
40.1  Anti Discrimination 
42 CFR 460.32(a)(2), 460.82(e)(1), 460.112(a) 
 
POs are prohibited from any discriminatory marketing practices with the 
exception of being able to target those individuals who may be eligible for 
the PACE program (Chapter 5, Section 20.1 of the PACE Manual). Moreover, 
PACE participants have 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. POs must comply with other anti-discrimination rules and 
requirements. 
 
40.2  Requirements Pertaining to Non-English Speaking Populations 
42 CFR 460.82(c) 
 
POs must have interpreter services available to assist non-English or limited 
English proficient (LEP) participants. POs must provide printed copies of all 
marketing materials to prospective and current participants in English and 
any other principal languages of the community, as determined by the state. 
40.3  Accessibility of Marketing Materials/Alternate Formats 
42 CFR 460.82(c)(2) 
 
POs must ensure all marketing materials are available in alternate formats 
so they are accessible and appropriate for individuals with disabilities (e.g., 
those with visual or hearing impairments). This includes providing 
documents in braille, if necessary or requested. Reasonable accommodations 
to communicate marketing information must be made in accordance with the 
Americans with Disabilities Act and the Rehabilitation Act (see Appendix 2). 
CMS expects that a PO will make the necessary accommodations (i.e., 
provide the alternate format) as expeditiously as possible. A PO may provide 
an audio alternative format with the agreement of the current or prospective 
participant. 
     
40.4  Font Size Rule 
42 CFR 460.82(e)(2)  
 
All marketing material text, including footnotes, must be printed with a font 
size equivalent to or larger than Times New Roman twelve (12)-point. The 
equivalency standard applies to both the height and width of the font. 
Exceptions to the font size rule, include: 
  Television ads; 
  ID cards; 
  Internal tracking numbers; 
  Logos with taglines; and 
  Media, such as newspapers and social media, where the PO does not 
have control over the font size.  
40.5  Use of Teletypewriter (TTY) Telephone Numbers 
Section 504 of the Rehabilitation Act 
 
POs must include a TTY telephone number in the same font, size, and style 
as the other telephone numbers whenever they list their customer service 
telephone number, except as outlined below. POs may use their own TTY 
telephone number or a state relay service, as long as the telephone number 
is accessible from TTY equipment. TTY customer service telephone numbers 
must be toll-free. 
TTY telephone numbers do not need to be included in: 
  Outdoor advertising (ODA) or banner/banner-like ads; and 
  Radio ads and radio sponsorships (e.g., sponsoring an hour of public 
radio) 
The TTY number used in television ads may be a different font, size, or style 
than other telephone numbers to limit confusion. 
    50  General Marketing Requirements  
50.1  Messages for Callers on Hold 
42 CFR 460.82(a) 
 
Hold time messages that play recorded information and discuss health-
education and general information (e.g., hours of operation, flu shot 
reminders) or generic statements such as Thank you for holding are not 
considered marketing and do not need to be submitted in HPMS for review 
or approval. 
However, hold time messages that promote the PACE organization or include 
benefit information are considered marketing and must be submitted in 
HPMS for review and approval.  POs are prohibited from using hold time 
messages to market other products. 
 
50.2 Use of Studies, Statistical Data, and Survey Results 
42 CFR 460.82(e)(2) 
 
Marketing material that uses or refers to studies, statistical data, or survey 
results regarding customer satisfaction, quality, or cost must include the 
following information, in text or as a footnote: 
  The name of the organization sponsoring the study; 
  Information about the POs relationship with the entity that conducted 
the study; and 
  The publication title, date, and page number. 
Note: This information should also be included in the comments field in 
HPMS.  
POs referencing studies or statistical data must include the following in their 
HPMS submission(s): 
  If a PO uses study data that includes aggregate marketplace 
information on several other POs, the PO is not required to submit 
data on all POs included in the study. However, the study details, such 
as the number of POs included, must be disclosed.  
  If a PO references a CMS study, the PO should include reference 
information (e.g., publication, date, page number) in the HPMS 
Marketing Material Transmittal comments field, or as a comment on a  separate page if the PO is not submitting the materials through HPMS. 
The PO is prohibited from using DHHS, CMS, or Medicare logos.  
  If a PO references non-CMS sponsored studies, it should submit the 
reference(s), sample size, and number of POs surveyed in the HPMS 
Marketing Material Transmittal comments. 
50.3  Prohibited Terminology/Statements 
42 CFR 460.82(a)(2),(e)(2) 
 
POs may only distribute marketing materials that are accurate and 
appropriately represent the PO, PACE Program, its benefits and services. 
This requirement extends to contractors that may be directly or indirectly 
involved in marketing the PO.  
POs may: 
  State that the PO is approved to participate in the Medicare/Medicaid 
programs and/or that it is authorized to administer Medicare/Medicaid 
benefits; and 
  Use the term Medicare covered or Medicaid covered to describe the 
benefits and services. 
  Compare their PO to another, provided the PO can support them (e.g., 
by studies or statistical data) and such comparisons are factually 
based and not misleading. 
POs must not: 
  Claim within their marketing materials that they are recommended or 
endorsed by the DHHS, CMS, or Medicare. This includes use of the 
DHHS name and logo, CMSs name and logo, and the words Medicare 
or Medicaid in a manner that conveys the false impression that such 
item is approved, endorsed, or authorized by DHHS or CMS; 
  Use absolute superlatives (e.g., the best, highest ranked, rated 
number 1) and/or qualified superlatives (e.g., one of the best, 
among the highest rank) unless they are substantiated with 
supporting data provided to CMS as part of the marketing review 
process or they are used in logos/taglines. The superlatives used and 
the data provided must be in context and not mislead consumers; or   50.4  Product Endorsements/Testimonials 
42 CFR 460.82(e)(2) 
 
Product endorsements and testimonials must adhere to the following 
guidelines:   
  The individual providing the testimonial or endorsement must identify 
the PO by name; 
  If the endorsement or testimonial is from a PACE participant, the PACE 
participant must be enrolled at the time the endorsement or 
testimonial was created. POs are reminded that they need to take all 
applicable measures to appropriately secure the necessary consent to 
use the participants statements and/or images. If desired, the PO may 
request the participants consent to continue using the endorsement in 
the case of their death;      
  Endorsements or testimonials from family members/care givers are 
permitted. The endorsements or testimonials must reference a time 
when the participant was enrolled. Family members/care givers may 
provide testimonials of deceased participants; however, the time in 
which the participant was enrolled in PACE must be referenced in the 
testimonial. As with participant endorsements, POs are responsible for 
taking applicable measures to appropriately secure consent;  
  The endorsement or testimonial cannot use fictitious quotes by 
physicians or other health care providers; and 
  The PO must clearly state that an individual offering a testimonial or 
endorsement was paid, or if the individual offering the testimonial or 
endorsement is a paid actor (i.e. paid actor portrayal), if applicable.   
Note: The re-publication of an individual users content or comment from 
social media sites (e.g., Facebook, Twitter, YouTube, LinkedIn) that 
promotes a PO is considered an endorsement or testimonial and must 
adhere to the guidance in this section. 
50.5  Marketing of Alternative Care Settings (ACS) 
42 CFR 460.82(a), 460.98(b)(2) 
 
When marketing ACSs, POs must make it clear that: 
  ACSs are not PACE centers; and 
  ACSs offer a more limited set of services than the PACE center.  60  Outreach and Promotional Activities 
60.1  Prospective Participant Contact 
42 CFR 460.82(e) 
POs and their subcontractors must not engage in direct, unsolicited contact 
with non-referred prospective participants, including outbound calls.  
Specifically, POs must not: 
  Make unsolicited outbound calls;  
  Conduct unsolicited door-to-door marketing; 
  Call former participants who have disenrolled, or current participants 
who are in the process of disenrolling, as a means of re-enrolling or 
retaining these individuals; 
  Call prospective participants who attended a PACE marketing or 
informational event, unless the individual gave explicit permission at 
the event for a follow-up call; 
  Advertise outside of the POs defined service area unless such 
advertising is unavoidable (e.g., advertising in print or broadcast 
media with a national audience or with an audience that includes some 
individuals outside of the service area); in this instance, the PO should 
clearly disclose its service area; or 
  Confirm receipt of marketing information unless the marketing 
materials were requested by prospective participants, family members, 
and/or caregivers. 
POs may conduct the following activities: 
  Contact their participants or their participants family members and/or 
caregivers to conduct normal business related to enrollment in PACE, 
including calls to participants who have been involuntarily disenrolled 
to resolve eligibility issues; 
  Call former participants after the disenrollment effective date to 
conduct disenrollment surveys for quality improvement purposes. 
Disenrollment surveys may be done by phone or sent by mail, but 
neither calls nor mailings may include sales or marketing information; 
  Call participants who gave explicit permission for a PO to contact 
them; 
  Provide an opt-out process for participants/family members/caregivers 
who no longer wish to receive email communications;    Return phone calls and messages from prospective participants, family 
members, and/or caregivers; 
  Contact participants/family members/caregivers via an automated 
telephone notification to inform them about general information such 
as the availability of flu shots, upcoming PACE changes, and other 
important PACE information; and 
  Call prospective participants, family members, and/or caregivers based 
on referrals from unsolicited contacts.  
 
Note: POs may make an initial follow-up call or mailing based on referrals 
from a prospective participants family, friends or neighbor, or from 
community partners and resources such as social workers, physician offices, 
and housing managers. However, if upon initial contact, the prospective 
participant/family member/caregiver shows no interest, further contact is 
prohibited. 
60.2  Use of Subcontracted or Downstream Entities  
42 CFR 460.82(e)(4) 
POs are prohibited from using third parties whose sole responsibility is to 
directly contact prospective participants to solicit enrollment.  
Note: This does not preclude POs from subcontracting administrative 
tasks such as printing and web development, nor does it preclude POs 
from working with the State Health Insurance Assistance Program 
(SHIP) and other community advocates. 
60.3  Nominal Gifts 
42 CFR 460.82(e) 
POs may offer gifts to prospective participants, provided they:  
  Have only Nominal Value (be worth $15 or less) based on the retail 
value of the item, with a maximum aggregate of $75 per person, per 
year;  
Note: POs should track and document items given to current 
participants. POs are not required to track pre-enrollment 
promotional items on a per person basis; however, they must  not structure pre-enrollment activities so as to avoid the $75 per 
year aggregate maximum. 
  Are offered to all prospective participants regardless of whether they 
enroll and without discrimination;  
  Are not be tied directly or indirectly to the provision of any other 
covered item or service; 
  If a nominal gift is one large gift (e.g., a concert or raffle), the total 
retail value must not exceed the nominal per person value based on 
attendance. For example, if 10 people are expected to attend an 
event, the nominal gift may not be worth more than $150 ($15 for 
each of the 10 anticipated attendees). For planning purposes, 
anticipated attendance may be used, but must be based on actual 
venue size, response rate, or ad circulation; and 
  Nominal gifts may not be in the form of cash or other monetary 
rebates, even if their worth is $15 or less. Cash gifts include charitable 
contributions made on behalf of prospective participants, and those 
gift certificates and gift cards that can be readily converted to cash, 
regardless of dollar amount. 
Note: Additional information regarding gifts and gift cards is available on 
the DHHS Office of Inspector Generals (OIGs) website (available at 
http://www.oig.hhs.gov/). 
60.4  Disclaimers Applicable to Advertising that Promotes a Nominal Gift 
42 CFR 460.82(e)(3) 
POs must include a written statement on all marketing materials promoting 
drawings, prizes, or any promise of a free gift that there is no obligation to 
enroll in PACE. For example: 
  Eligible for a free drawing and prizes with no obligation  
Free drawing without obligation 
70  Websites  
70.1  General Website Requirements 
42 CFR 460.82(a)(2), 460.82(b), 460.82(e) 
POs may choose to have a website. POs must ensure that their website, 
including websites owned by parent companies that include PACE content,  meet all marketing requirements outlined in this chapter. PO websites must 
be compliant with web-based technology and information standards for 
people with disabilities, including Section 508 of the Rehabilitation Act. 
In addition, PO websites must: 
  Provide a separate and distinct section for PACE information if the 
website includes information regarding other lines of business; 
  Notify individuals that they will leave the POs PACE-specific 
website/section if there is a link to non-PACE information or to a 
different website; 
  Clearly label all hyperlinks;  
  Include a date stamp on each webpage with the date the page was 
last updated; 
  Include the toll-free customer service number and hours of operation, 
TTY number, and either a physical or Post Office Box address;  
  Include information on participant rights and responsibilities upon 
disenrollment;  
  Provide the POs service area; 
  Include information that the PACE program will be the participants 
sole service provider and that the PO guarantees access to services, 
but not to a specific provider; 
  Provide instructions on how to appoint a representative and a link to 
the downloadable version of the CMS Appointment of Representative 
Form (CMS Form-1696); and  
  A description of and information on how to file a grievance and an 
appeal by participants, their family members, or representatives. This 
must include: 
  Phone number(s) for receiving oral requests; 
o
  Mailing address for written requests; 
o
  Fax number for written requests; 
o
  Links, if applicable, to any forms created by the PO for appeals 
o
and grievances; and 
  Contact numbers for participants, family members, and/or 
o
representatives to use for process or status questions. 
    80  Materials Not Subject to Marketing Review 
42 CFR 460.82(b) 
CMS views the following as materials largely designed to get the consumers 
attention and provide contact information for purposes of requesting more 
information. POs must ensure that these materials meet applicable 
requirements and should have a system to track, maintain these materials 
so that they may be made available to CMS upon request. 
These are not subject to CMS review and approval and should not be 
submitted in HPMS: 
  HIPAA Privacy notices (subject to enforcement by the Office for Civil 
Rights within the U.S. Department of Health and Human Services 
(DHHS)); 
  Press releases that do not include any PACE-specific information (e.g., 
information about benefits, premiums, co-pays, deductible, benefits, 
how to enroll, networks, etc.); 
  Advertising/Promotional Materials (see Appendix 1); 
  Banner and Banner-Like ads (see Appendix 1); 
  Outdoor Advertising (ODA) (see Appendix 1); 
  Certain participant newsletters, unless sections are used to encourage 
enrollment or disenrollment;  
  Letterhead/fax coversheets that do not include promotional language; 
  General health promotion materials that do not include any specific 
PO-related information and are educational in nature (e.g., health 
education and disease management materials); 
  Materials to educate participants, family members/caregivers, and Ad-
Hoc Participant Communications Materials (see Appendix 1) that are 
not being distributed to prospective participants, or lack PACE-specific 
information; 
  Participant surveys; and 
  Newsletters to professional referral sources to keep them up-to-date 
on the PACE program. 
  Materials that provide information to current participants, family 
members, or caregivers, about their current enrollment in the PACE 
program or provide non-PACE-specific health information.     Items such as billboards, bus or bench ads, etc. that advertise the 
POs name and provide contact information without providing more 
detailed information. 
     
Appendix 1  Definitions 
 
Ad-hoc Participant Communications Materials 
Ad-hoc participant communications materials provide information that is 
targeted to current participants or a customized/limited subset of 
participants. They do not include information about the POs benefit 
structure. They apply to specific situations, cover participant-specific 
processes, or other operational issues. These materials are not marketing 
materials. 
Advertising/Promotional Materials 
Advertising/promotional materials are primarily intended to attract or appeal 
to a prospective participant. Advertising/promotional materials contain less 
detail than other marketing materials, and may provide benefit information 
at a level to entice a prospective participant to request additional 
information. 
Alternate Formats 
Alternate formats are methods/forms of communication used to convey 
information to participants with disabilities (e.g., Braille, large print, and 
audio). These materials address reasonable accommodation requirements to 
communicate marketing information. 
Banner and Banner-Like Ads 
Banner ads are typically in television ads and flash information quickly 
across a screen with the sole purpose of enticing a prospective participant to 
contact the PO to enroll or request more information. A banner-like ad is 
usually in some media other than television (e.g., outdoor advertising and 
internet banner ads), and is intended to be very brief and to entice someone 
to call the PO or to alert someone that information is forthcoming. These 
types of ads are considered informational and are not considered marketing 
materials. 
Enrollment Materials 
Enrollment materials are used to convey information specific to enrollment 
and disenrollment. Enrollment materials that are used prior to enrollment 
are considered marketing materials (see Appendix 2).  Health Plan Management System (HPMS) 
HPMS is a web-enabled information system that supports the 
implementation and ongoing operations of POs. HPMS and its software 
modules may be used by POs to enter, track, and maintain marketing 
materials submitted to CMS for review and approval.  
Marketing Materials 
Marketing materials are information POs provide to the public about its 
program. Marketing materials can be used to educate prospective 
participants. These materials must be approved by CMS and the SAA. 
Mobile Applications (Apps) 
Mobile apps are programs that are typically downloaded and run on a mobile 
device. Mobile apps differ from websites in that a website is accessed via a 
devices web browser.  
Nominal Value 
Nominal value is currently defined by CMS as being worth $15 or less, based 
on the retail value of the item in question. Any promotional activity or item 
(i.e., gift) offered by POs, including those that will be used to encourage 
retention of participants, must be of nominal value.  
Note: CMS sets the maximum, not the minimum, for nominal value. 
Outdoor Advertising (ODA) 
Outdoor advertising is outdoor marketing intended to capture the attention 
of a passing audience (e.g., billboards, signs attached to transportation 
vehicles), and to influence them to request more detailed information on the 
product being advertised. 
Programs of All-inclusive Care for the Elderly (PACE) 
PACE is a managed care Medicare/Medicaid program authorized under 
sections 1894, 1905(a), and 1934 of the Social Security Act and Chapter 42 
of the Code of Federal Regulations, Part 460 (see Appendix 2). 
PACE Program Agreement 
A PACE program agreement is an agreement between a PO, CMS, and the 
SAA for the operation of a PACE program. A PO may only operate in a state 
in accordance with a PACE program agreement. 
    Template Material 
A template material is any marketing material that includes placeholders for 
variable data to be populated at a later time. 
Website Address 
A website address is an address that is typed into an internet browser, also 
known as a Universal Resource Locator (URL). 
     
Appendix 2 - Related Laws and Regulations  
(Rev. 4, Issued: 08-30-13, Effective: 05-08-13, Implementation: 10-29-13)  
 
Chapter 42 of the Code of Federal Regulations Part 460  
The PACE regulations can be found at https://www.gpo.gov/fdsys/granule/CFR-
2009-title42-vol4/CFR-2009-title42-vol4-part460 
 
Privacy and Confidentiality  
Additional information on the HIPAA Privacy Rule and its use and disclosure 
requirements can be found at http://www.hhs.gov/ocr/privacy/  
 
Americans with Disabilities Act  
Additional information on the Americans with Disabilities Act can be found at 
http://www.ada.gov/  
 
Sections 501 and 504 of the Rehabilitation Act  
Additional information on sections 501 and 504 of the Rehabilitation Act can be 
found at  
http://www.dol.gov/oasam/regs/statutes/sec504.htm and 
http://transition.fcc.gov/cgb/dro/504/disability_primer_1.html  
 
HPMS, Connectivity Guide and User Instructional Guides  
Additional information can be found at https://www.hpms.cms.gov 
 
Section 508 of the Rehabilitation Act  
(Section 508 of the Rehabilitation Act (29 U.S.C. 794d), as amended by the 
Workforce Investment Act of 1998 (P.L. 105-220), August 7, 1998)  
All POs that choose to create and maintain an Internet website must ensure that 
it is compliant with web-based technology and information standards for people 
with disabilities as specified in section 508 of the Rehabilitation Act. For 
additional information, please go to the following website address: 
http://www.section508.gov 
  
Note: These Federal requirements are extended to all POs through the 
requirements for non-discrimination under Federal grants and programs 
(29 USC 794).  
 
PACE Enrollment and Disenrollment  
Additional information on PACE Enrollment and Disenrollment can be found in 
the PACE Manual at http://www.cms.gov/Regulations-and-
Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-
Items/CMS019036.html  
  Sections 1894, 1905(a) and 1934 of the Social Security Act  
Additional information on the PACE provisions in the Social Security Act can be 
found at https://www.socialsecurity.gov/OP_Home/ssact/title18/1894.htm;  
https://www.socialsecurity.gov/OP_Home/ssact/title19/1934.htm and 
http://www.socialsecurity.gov/OP_Home/ssact/title19/1905.htm