Bill > H781

This bill establishes the Program of All-Inclusive Care for the Elderly (PACE), a comprehensive healthcare service model designed to help seniors remain in their community while receiving integrated medical and social long-term care services. The program will be administered by MassHealth and targets dually eligible individuals (those qualifying for both Medicare and Medicaid) who meet specific eligibility criteria, such as requiring skilled nursing facility-level care but able to live safely in a community setting. PACE will provide a wide range of services through interdisciplinary care teams, including medical, health care, and social services delivered in day-health centers, homes, and specialty or inpatient settings. Enrollment is voluntary, and participants can disenroll monthly, with services covering Medicare Part A and B, Medicaid-covered services, and mental health and substance abuse treatments. The bill requires MassHealth to educate consumers about PACE, provide detailed educational materials, and ensure that enrollment is not induced by gifts or payments. Importantly, the program will use capitation agreements with Medicare and Medicaid, meaning PACE organizations will be financially responsible for the services they authorize. The legislation also mandates privacy standards, establishes income-based payment guidelines, and provides a process for appealing eligibility decisions.

Health and Social Services

https://malegislature.gov/Bills/194/H781