Bill > H4804

This bill establishes the Program of All-Inclusive Care for the Elderly (PACE) within MassHealth, creating a comprehensive healthcare delivery model for elderly residents who meet specific eligibility criteria. The program will provide integrated medical and long-term care services through interdisciplinary care teams, allowing seniors who would typically require nursing home care to remain in their community. Enrollees must meet skilled nursing facility level of care requirements and be able to live safely in a community setting. The bill mandates that PACE enrollment is voluntary, with participants having the right to disenroll monthly, and requires MassHealth to contract with PACE organizations to deliver a comprehensive network of medical, healthcare, and social services. The legislation specifies that services will cover Medicare Part A and B, Medicaid-covered services, and mental health and substance abuse treatments. MassHealth is required to provide educational materials to potential enrollees, conduct outreach to local aging organizations, and ensure transparency in the enrollment process. The bill also establishes payment mechanisms through dual capitation agreements with Medicare and Medicaid, sets privacy standards consistent with HIPAA regulations, and provides an appeals process for applicants. Importantly, the program aims to provide comprehensive, coordinated care that keeps elderly individuals in their communities while meeting their medical and social service needs.

Budget and Finance

Joint Committee on Aging and Independence (Other)

https://malegislature.gov/Bills/194/H4804