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SF2755 (Legislative Session 94 (2025-2026))

Program of All-Inclusive Care for the Elderly service delivery system implementation provision

Related bill: HF1937

AI Generated Summary

Purpose

The bill aims to implement the Program of All-Inclusive Care for the Elderly (PACE) in Minnesota. This program integrates healthcare services for the elderly, improving service coordination and potentially reducing healthcare costs by keeping seniors in their communities as long as possible.

Main Provisions

  • PACE Establishment: The bill formally introduces PACE, as permitted by federal laws. It aims to provide comprehensive services for elderly eligible individuals through nonprofit organizations.

  • Eligible Participants: Seniors who qualify for Medicaid, are 55 or older, and meet specific health criteria can enroll in PACE. Participants will get care outside typical institutional settings, mainly in community environments.

  • Service Coordination: The bill ensures the integration of medical and social services to enhance the quality of life for enrolled individuals and encourage community living instead of long-term institutional care.

  • Contracts and Agreements: The Minnesota Department of Human Services will only contract with approved PACE organizations. These contracts will specify service areas, organizational commitments, and operational structures.

  • Payment and Funding: The bill proposes developing a rate-setting methodology for reimbursement of PACE services, ensuring conformity with federal regulations and effective use of funds.

  • Implementation Timeline: A competitive bidding process for PACE providers must be established by the end of 2025, with services starting by January 2027.

Significant Changes to Existing Law

  • Coordination with Federal Regulations: The bill stipulates the need for contract agreements with both state and federal bodies, ensuring compliance with federal Medicare and Medicaid standards.

  • Capitated Payment Model: PACE will use a capitated funding model, which involves pre-set fees for each enrolled Medicaid participant to cover their comprehensive care.

  • Regulatory Modifications: The bill provides for specific exceptions in existing Minnesota Rules to accommodate new models of integrated care services under PACE.

Relevant Terms

  • PACE (Program of All-Inclusive Care for the Elderly)
  • Medicare and Medicaid Services
  • Capitation Payments
  • Long-Term Care Services
  • Managed Care Organizations
  • Elderly Waiver Services
  • Community-Based Services

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
March 19, 2025SenateFloorActionIntroduction and first reading
March 19, 2025SenateFloorActionReferred toHuman Services

Citations

 
[
  {
    "analysis": {
      "added": [
        "Clarifications on demonstration projects for integrated delivery systems.",
        "Authorization for the commissioner to seek federal authority and contract with Medicare-approved plans."
      ],
      "removed": [
        "Restrictions on initiating projects without county board approval were eliminated for certain populations."
      ],
      "summary": "This amendment modifies regulations concerning alternative service delivery systems for elderly and disabled persons under section 256B.69, subdivision 23.",
      "modified": [
        "Increased cooperation and role of the commissioner in project demonstrations and health plan terminations."
      ]
    },
    "citation": "256B.69",
    "subdivision": "subdivision 23"
  },
  {
    "analysis": {
      "added": [
        "Consultation with an independent actuary for determining appropriate payment rates."
      ],
      "removed": [],
      "summary": "This section addresses rate setting and performance withholds for managed care plan payments.",
      "modified": [
        "Details on withheld funds and performance targets for managed care plans."
      ]
    },
    "citation": "256L.12",
    "subdivision": "subdivision 9"
  },
  {
    "analysis": {
      "added": [
        "Specifies liability for elderly waiver services."
      ],
      "removed": [],
      "summary": "Amends the definition of managed care organization under section 256S.02, subdivision 17.",
      "modified": [
        "Includes cross-reference updates to related sections."
      ]
    },
    "citation": "256S.02",
    "subdivision": "subdivision 17"
  }
]

Sponsors