This bill establishes and implements the Program of All-Inclusive Care for the Elderly (PACE) in Minnesota, which integrates Medicare and Medicaid services to provide comprehensive, coordinated care for elderly individuals who require long-term services and supports.

Key Provisions of the Bill:

1. Amendments to Existing Laws:

   • Modifies Minnesota Statutes 2024, including 256B.69, 256L.12, and 256S.02, to incorporate PACE-related provisions.
   • Expands alternative integrated delivery systems to include PACE, facilitating better coordination of acute and long-term care services.

2. Establishment of PACE (New Section 256B.6902):

   • Defines Eligibility: Individuals 55 and older who meet Medicaid waiver or nursing home level-of-care requirements are eligible to enroll in PACE.
   • Service Delivery Model: Provides a broad range of medical, social, and long-term care services primarily in outpatient settings, adult day centers, enrollees’ homes, or institutional settings.
   • Enrollment & Disenrollment: Participation in PACE is voluntary, with enrollees able to disenroll at any time.
   • Capitated Payment System: PACE providers will receive fixed per-member payments from Medicaid, ensuring cost control while maintaining service quality.

3. Contracts with PACE Organizations:

   • PACE providers must be non-profit organizations that contract with both the Centers for Medicare & Medicaid Services (CMS) and the Minnesota Department of Human Services.
   • Contracts must delineate service areas, eligibility criteria, quality assurance measures, and financial responsibilities of the PACE providers.

4. Implementation Timeline:

   • By October 1, 2025: The state must submit a Medicaid state plan amendment to CMS for PACE approval.
   • By December 31, 2025: The commissioner must establish a competitive bidding process for PACE provider selection.
   • By June 30, 2026: Selected PACE organizations must establish operations.
   • By January 1, 2027: PACE providers must begin offering services to eligible seniors.

5. Financial and Payment Structures:

   • The bill establishes a methodology for Medicaid capitation rate-setting for PACE services starting in 2025, ensuring cost-effectiveness while maintaining service quality.
   • Managed Care Organizations will assume financial risk and responsibility for PACE-related services.

6. Performance-Based Withholding Expansion:

   • Expands existing Medicaid performance-based withholdings to include PACE, ensuring cost containment and quality improvement initiatives.

Purpose & Expected Impact:

• Improves quality of life for older adults by offering integrated, person-centered care.
• Reduces healthcare costs by limiting unnecessary hospital and nursing home admissions.
• Maintains seniors in their communities through accessible, comprehensive healthcare services.
• Encourages health plan accountability and performance improvements by tying payments to achieved benchmarks.

This bill aims to enhance Minnesota’s long-term care system by officially incorporating PACE, ensuring seniors receive high-quality, cost-effective, and well-coordinated care.