Bill Text: NJ A4168 | 2014-2015 | Regular Session | Introduced
Bill Title: Requires providers to submit to DHS expenditure details of enrollees in Program of All-Inclusive Care for the Elderly.
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Passed) 2015-11-09 - Approved P.L.2015, c.152. [A4168 Detail]
Download: New_Jersey-2014-A4168-Introduced.html
Sponsored by:
Assemblyman JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
Assemblyman VINCENT MAZZEO
District 2 (Atlantic)
Assemblyman TIMOTHY J. EUSTACE
District 38 (Bergen and Passaic)
Assemblyman BOB ANDRZEJCZAK
District 1 (Atlantic, Cape May and Cumberland)
SYNOPSIS
Requires providers to submit to DHS expenditure details of enrollees in Programs of All-Inclusive Care for the Elderly.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning certain programs for the elderly and disabled and amending P.L.1997, c.296.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.1997, c.296 (26:2H-88) is amended to read as follows:
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. s.1395 et seq.).
"PACE" means the "Program [for] of All-Inclusive Care for the Elderly," operated by a public, private, nonprofit, or proprietary entity, as permitted by federal law. The program is a comprehensive health and social services delivery system that integrates acute and long-term care services. PACE 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.
"Pre-PACE" means a PACE program in its initial start-up phase and includes the same comprehensive scope of services as a PACE program. A 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.
(cf: P.L.1997, c.296, s.1)
2. Section 2 of P.L.1997, c.296 (C.26:2H-89) is amended to read as follows:
2. A PACE or Pre-PACE program shall operate in the State only in accordance with a contract with the Department of Human Services pursuant to the provisions of [this act] P.L.1997, c.296 and P.L. , c. (pending before the Legislature as this bill). A contract entered into on or after the effective date of P.L. , c. (pending before the Legislature as this bill) shall require, at a minimum, that a provider of services under the PACE or Pre-PACE program submit to the department, on a monthly basis, the expenditure details of the encounters which a person enrolled in one of the programs has had with the program. The department shall utilize these details to analyze capitated rates and help ensure the efficient utilization of services from the program.
The programs shall not be
subject to the requirements of
P.L.1973, c.337 (C.26:2J-1 et seq.).
(cf: P.L.2012, c.17, s.245)
3. This act shall take effect on the first day of the fourth month next following the date of enactment, except the Commissioner of Human Services may take any anticipatory administrative action in advance as shall be necessary for the implementation of this act.
STATEMENT
This bill amends the law governing the Program of All-Inclusive Care for the Elderly (PACE and Pre-PACE programs), which are operated by public, private, nonprofit, or proprietary entities which contract with the Department of Human Services (DHS) to provide comprehensive health and social services in the community to disabled and frail elderly persons who are certified as nursing home eligible. The bill provides that contracts with PACE and Pre-PACE program providers, that are entered into on or after the bill's effective date, are to require providers to submit to DHS, on a monthly basis, expenditure details of the encounters which an enrollee has had with the program.
The bill further requires that DHS utilize these expenditure details to analyze capitated rates and help ensure the efficient utilization of services from the programs.
Lastly, the bill makes a technical change to the name of the program.
