S.F. No. 5007 Summary

• Creates the Program of All-Inclusive Care for the Elderly (PACE) as a Minnesota Medicaid program authorized under federal law to provide community-based, capitated long-term care services to individuals 55 and older at risk of institutionalization.

• Establishes program requirements including: maintaining eligible persons at home as alternative to institutionalization, coordinating medical and nonmedical services, ensuring capitation payments do not exceed 100 percent of comparable fee-for-service or managed care costs, and implementing an interdisciplinary team approach to care management.

• Requires the commissioner of human services to submit a PACE state plan amendment to federal Centers for Medicare and Medicaid Services by October 1, 2024, establish an application process for PACE organizations by December 31, 2024, and have service operations begin January 1, 2026.

• Mandates PACE organizations assume full financial risk for all participant costs including hospital and nursing home care, maintain solvency per federal regulations, and provide a comprehensive benefit package covering all Medicare and Medicaid services plus additional services deemed necessary by the interdisciplinary team.

• Directs the commissioner to develop actuarially sound capitation rates using standardized methodology, calculate upper payment limits based on comparable populations, and certify participant eligibility for services beginning July 1, 2025.