Program for All-Inclusive Care for the Elderly service delivery system implemented.
Impact
The bill carries significant implications for state health laws by embedding a process for maintaining continuity of care and potentially reducing costs associated with hospitalizations and emergency services for elderly patients. Through the PACE model, enrollees will receive coordinated services aimed at ensuring they can remain in their communities, thus lessening the need for institutionalization. The commissioner of human services will oversee the PACE program and will be tasked with establishing payment structures that comply with federal guidelines, ensuring that service delivery meets the required standards of quality and efficiency.
Summary
House File 1937 (HF1937) proposes the establishment of the Program of All-Inclusive Care for the Elderly (PACE) in Minnesota, designed to provide comprehensive health services to elderly individuals eligible for Medicaid. This program aims to integrate acute and long-term care for seniors, allowing them to receive services that are typically split across various programs. HF1937 outlines that individuals age 55 and older who meet specific criteria can enroll in this program, thereby allowing for coordinated care through a single provider rather than accessing multiple services under different management systems. The bill sets the stage for increased flexibility in service delivery for seniors needing long-term care.
Contention
However, there are notable points of contention surrounding HF1937, particularly related to how these integrated services will be funded and delivered. Critics may raise concerns about the program's sustainability, especially regarding the capitation payment model that requires the state to effectively manage costs while providing comprehensive care. Additionally, the transitioning of service provision from multiple entities to a single PACE provider may prompt discussions around accountability, especially if service quality does not meet established standards. Stakeholders, including health care providers and advocacy groups, will undoubtedly have varied opinions on the efficacy of such an integrated model as it is rolled out across the state.
Rates and rate floors modified for services involving disability and elderly waivers, customized living, nursing and intermediate care facilities, personal care assistance, home care, nonemergency medical transportation, and community first services and supports; provisions modified; residential settings closure prevention grant program established; and money appropriated.
MinnesotaCare and medical assistance enrollee cost-sharing elimination; individual, small group and State Employee Group Insurance Program cost-sharing prohibition
Enrollee cost-sharing eliminated under medical assistance and MinnesotaCare; and individual, small group, and State Employee Group Insurance Program plans prohibited from including cost-sharing.
Home and community-based services systemic critical incident review team established, adult foster care and community residential setting licensing provisions clarified, substance use disorder treatment requirements modified, councils and committees extended, provider-controlled and own-home settings clarified, and chemical health pilot program obsolete language repealed.
Mental health provider staffing, documentation, and diagnostic assessment requirements modified; certification process required; assertive community treatment and behavioral health home services staff requirements modified; adult rehabilitative mental health services provider entity standards modified; managed care contract requirements modified; grant data and reporting requirements modified; and family peer support services eligibility modified.
Manufacturers required to report and maintain prescription drug prices, filing of health plan prescription drug formularies required, health care coverage provisions modified, prescription benefit tool requirements established, and prescription drug benefit transparency and disclosure required.