SF2755

Purpose of the Bill

The bill aims to establish and implement the Program of All-Inclusive Care for the Elderly (PACE) within Minnesota. This program is intended to improve service delivery and coordination for elderly persons and individuals with disabilities by integrating acute and long-term care services.

Main Provisions

• PACE Program Establishment: The bill officially establishes PACE as an authorized service delivery system for elderly individuals in Minnesota. It is designed to provide comprehensive management of medical and non-medical services primarily in outpatient settings.
• Eligibility and Enrollment: Persons aged 55 and older, who meet specific criteria, can opt to enroll in PACE. This includes those requiring services under elderly and disability waivers. Participants enrolling in PACE will not be eligible for payment through other Medicare or Medicaid programs.
• Services and Implementation: The commissioner is tasked with coordinating various services aimed at maintaining enrollees in the community rather than in institutional care. This includes adult day centers and home services.
• Contracts and Compliance: PACE organizations must enter into contracts with the state, meeting federal requirements. A competitive bidding process is established to solicit PACE organizations, which are required to begin operations by January 2027.
• Payment and Reimbursement: A methodology for establishing payment rates to medical assistance-eligible PACE enrollees is to be developed by the commissioner, with implementation set for January 2027.
• Performance Targets and Withholding: Adjustments to withhold payments for managed care plans under certain conditions to ensure improved performance, such as reducing emergency room visits and hospital admissions.

Significant Changes to Existing Law

• Expands the scope of integrated care programs by including PACE, allowing a more comprehensive service offering to the elderly demographic and individuals with disabilities under Minnesota law.
• Introduces specific contractual and operational guidelines for PACE providers, including risk-based financial responsibilities and service standards.
• Alters the existing rate-setting and performance withhold mechanisms for managed care organizations, stipulating new performance targets related to reducing the use of emergency and inpatient hospital services.

Relevant Terms

• PACE (Program of All-Inclusive Care for the Elderly)
• Managed care organizations
• Medicare and Medicaid
• Capitation payments
• Elderly waiver services
• Home and community-based services
• Risk-based financing