42 CFR §460.30

1. (a)A PACE organization must have an agreement with CMS and the State administering agency for the operation of a PACE program by the PACE organization under Medicare and Medicaid.
2. (b)The agreement must be signed by an authorized official of CMS, the PACE organization and the State administering agency.
3. (c)CMS may only sign program agreements with PACE organizations that are located in States with approved State plan amendments electing PACE as an optional benefit under their Medicaid State plan.