CHAPTER 296

 

An Act concerning PACE programs and supplementing Title 26 of the Revised Statutes.


    Be It Enacted by the Senate and General Assembly of the State of New Jersey:


C.26:2H-88 Definitions relative to PACE programs.

    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 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.

    "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.


C.26:2H-89 PACE, pre-PACE program operation.

    2.    A PACE or Pre-PACE program shall operate in the State only in accordance with a contract with the Department of Health and Senior Services, which shall be prepared in consultation with the Department of Human Services, and pursuant to the provisions of this act.

    The programs shall not be subject to the requirements of P.L.1973, c.337 (C.26:2J-1 et seq.).


C.26:2H-90 Cash reserves, demonstration.

    3.    A PACE or Pre-PACE program shall, at the time of entering into the initial contract and at each renewal thereof, demonstrate cash reserves to cover expenses in the event of insolvency.

    a.    The cash reserves, at a minimum, shall equal the sum of:

    (1)  One month's total capitation revenue; and

    (2)  One month's average payment to subcontractors.

    b.    The program may demonstrate cash reserves to cover expenses of insolvency with one or more of the following: reasonable and sufficient net worth, insolvency insurance, letters of credit or parental guarantees.


C.26:2H-91 Enrollment, disenrollment terms.

    4.    A PACE or Pre-PACE program shall provide full disclosure regarding the terms of enrollment and the option to disenroll at any time to all persons who seek to participate or are participants in the program.


    5.    This act shall take effect immediately.


    Approved January 8, 1998.