MA H781

Establishes the Program of All-Inclusive Care for the Elderly (PACE) under MassHealth to provide comprehensive medical and long-term care services to older adults at risk of nursing facility placement, allowing them to remain in the community

Enrollees must meet skilled-nursing-facility level of care criteria, reside in a PACE service area, and be able to live safely in a community setting; services are delivered through day-health centers, at home, and in specialty or inpatient settings

Enrollment is voluntary with the right to disenroll any month; disenrollment notices received by the 20th of the month take effect the first day of the following month

MassHealth may grant presumptive eligibility for up to 90 days to PACE applicants, and current MassHealth standard enrollees who meet clinical criteria are deemed presumptively eligible

PACE organizations receive capitation payments (fixed monthly per-enrollee amounts) through dual agreements with Medicare and Medicaid, with rates required to ensure quality care regardless of enrollees' physical or mental health conditions