[Passed Both Houses]
SENATE, No. 2051
STATE OF NEW JERSEY
INTRODUCED MAY 8, 1997
By Senators BASSANO, LIPMAN,
Assemblywoman Vandervalk and Assemblyman Blee
An Act concerning PACE programs and supplementing Title 1[17B] 261 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
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.§1395 et seq.).
"PACE" means the "Program for All-Inclusive Care for the Elderly," operated by 1[either]1 a public 1[or],1 private nonprofit 1[community-based organization] or proprietary entity, as permitted by federal law1. The program is a comprehensive health and social services delivery system that integrates acute and long-term care services 1[on a dually capitated, Medicare and Medicaid, prepaid contractual basis for disabled and frail elderly persons who have been certified as needing long-term care services, allowing these persons to remain in their community]1. 1PACE 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 program1[, but which contracts with the Medicaid program on a prepaid capitated basis for a more limited scope of services than in a PACE program and which receives payment on a fee-for-service basis for the balance of services provided by or through the program]1. 1A 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
1[2. An entity seeking to operate a Pre-PACE or a PACE program in the State under contract with the State Medicaid program shall apply to the Department of Banking and Insurance for a certificate of authority pursuant to this act and shall submit such information about the program and remit such application fees as shall be required by the Commissioner of Banking and Insurance, by regulation.
a. Following receipt of an application for a certificate of authority, the Commissioner of Banking and Insurance shall review it in consultation with the Commissioners of Health and Senior Services and Human Services and notify the applicant of any deficiencies contained therein within 30 days.
b. The Commissioner of Banking and Insurance shall determine whether the applicant is financially sound and may reasonably be expected to meet its obligations to program recipients. The commissioner may require the applicant, if he deems it necessary in order to ensure that the applicant will be able to meet its obligations to program recipients, to deposit with the commissioner, or with an entity or trustee acceptable to the commissioner through which a custodial or controlled account is utilized, cash, securities or any combination of these or other measures that is acceptable to the commissioner in an amount established by the commissioner.
c. The Commissioner of Banking and Insurance shall issue the certificate of authority within 30 days of the receipt of the application if he finds that the applicant meets the standards required by the Department of Banking and Insurance and the Departments of Health and Senior Services and Human Services pursuant to this act.
d. A Pre-PACE program which seeks to convert its certificate of authority to a PACE program shall notify the Commissioner of Banking and Insurance and shall meet such additional requirements applicable to a PACE program as established by the commissioner pursuant to this act.
e. A certificate of authority shall be valid for three years and may be renewed in accordance with regulations adopted by the Commissioner of Banking and Insurance.]1
1[3. a. The Commissioner of Banking and Insurance, in consultation with the Commissioners of Health and Senior Services and Human Services, shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) regarding financial solvency of Pre-PACE and PACE programs.
b. The Commissioners of Health and Senior Services and Human Services, shall jointly adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.)
regarding relevant standards for Pre-PACE and PACE programs.]1
12. 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.).1
13. 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.1
14. 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.1
1[4.] 5.1 This act shall take effect immediately.
Authorizes PACE and Pre-PACE programs to contract with Department of Health and Senior Services.