The bill establishes the Program of All-Inclusive Care for the Elderly (PACE) under Chapter 118E of the General Laws, aiming to provide comprehensive medical and long-term care benefits to eligible Massachusetts residents. It introduces a new section, 9G, which defines key terms such as "capitation," "dually eligible," "enrollee," and "PACE organization." The bill mandates that MassHealth administer the PACE program, ensuring that enrollees meet specific criteria, including the need for skilled-nursing-facility level care and the ability to live safely in a community setting. MassHealth will contract with PACE organizations to deliver integrated services and will ensure that enrollment is voluntary, allowing enrollees to disenroll with proper notice.
Additionally, the bill outlines the benefits provided to PACE enrollees, which include services covered by Medicare and Medicaid, and emphasizes consumer education regarding enrollment choices. It prohibits PACE organizations and MassHealth from offering inducements for enrollment and requires outreach to local aging organizations. The bill also allows for presumptive eligibility for applicants and establishes dual capitation agreements for payment, ensuring that PACE programs can provide quality care. Furthermore, it mandates compliance with privacy standards and authorizes MassHealth to create regulations to enforce the new provisions.