Senator PETER J. BARNES, III
District 18 (Middlesex)
Requires providers to submit to DHS expenditure details of enrollees in Programs of All-Inclusive Care for the Elderly.
CURRENT VERSION OF TEXT
As reported by the Senate Health, Human Services and Senior Citizens Committee on June 15, 2015, with amendments.
An Act concerning certain programs for the elderly and disabled and amending P.L.1997, c.296.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1997, c.296 (26:2H-88) is amended to read as follows:
1. As used in this act:
"Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.).
"Medicare" means the program established pursuant to Pub.L.89-97 (42 U.S.C. s.1395 et seq.).
"PACE" means the "Program [for] of All-Inclusive Care for the Elderly," operated by a public, private, nonprofit, or proprietary entity, as permitted by federal law. The program is a comprehensive health and social services delivery system that integrates acute and long-term care services. PACE is a capitated program which provides services to disabled and frail elderly persons who are certified by the State as nursing home eligible to maximize their autonomy and continued independence.
1["Pre-PACE" means a PACE program in its initial start-up phase and includes the same comprehensive scope of services as a PACE program. A Pre-PACE program may contract with the State to provide services to Medicaid-eligible persons on a capitated basis for a limited scope of the PACE service package, with the remaining services reimbursed directly to the service providers by the Medicaid and Medicare programs.]1
(cf: P.L.1997, c.296, s.1)
2. Section 2 of P.L.1997, c.296 (C.26:2H-89) is amended to read as follows:
2. A PACE 1[or Pre-PACE]1 program shall operate in the State only in accordance with a contract with the Department of Human Services pursuant to the provisions of [this act] P.L.1997, c.296 and P.L. , c. (pending before the Legislature as this bill). A contract entered into on or after the effective date of P.L. , c. (pending before the Legislature as this bill) shall require, at a minimum, that a provider of services under the PACE 1[or Pre-PACE]1 program submit to the department, on a monthly basis, the expenditure details of the encounters which a person enrolled in one of the programs has had with the program. The department shall utilize these details to analyze capitated rates and help ensure the efficient utilization of services from the program.
The programs shall not be subject to the requirements of P.L.1973, c.337 (C.26:2J-1 et seq.).
(cf: P.L.2012, c.17, s.245)
3. This act shall take effect on the first day of the 1[fourth] thirteenth1 month next following the date of enactment, except the Commissioner of Human Services may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.