HB 782

This bill requires t he bureau of TennCare to authorize an additional PACE program as a pilot in one of the two grand divisions where a PACE prog ram did not exist in 2024. A PACE program is a program of all-inclusive care for elderly persons that provides comprehensive, integrated acute and long-term care services for frail, elderly individuals who require the level of care provided in a nursing f acility and who meet eligibility criteria established by the federal centers for medicare and medicaid services. The director of TennCare must ensure PACE applicants meet the program eligibility criteria under federal law and regulations and certify that applicants are qualified to be PACE providers in the proposed geographic service area. Letter of Intent Required This bill requires a prospective PACE applicant for the pilot program to submit a letter of intent to the bureau indicating the prospective applicant's intent to submit a PACE application. The letter of intent must identify (i) t he prospective applicant , ( ii ) t he proposed service area, including the proposed zip codes and a service area map , and ( iii ) t he proposed site location for the appli cant's PACE center. Market Analysis Required This bill requires PACE applicants to submit a market analysis of the proposed service area, which must include (i) a n estimate of the number of PACE eligible individuals , (ii) a description of the methodolo gy and assumptions used to determine the potential membership , (iii) the projected market capture and saturation rat e and ( iv ) a demonstration that there is an unmet need for a PACE program in the proposed service area. Referrals This bill requires t h e director to ensure that managed care organizations and all appropriate options counseling entities consider the availability of the PACE program when considering whether to refer a recipient to a nursing facility or other long-term care facility and esta blish protocols for the referral of eligible persons to the PACE program. Quality and Performance Standards This bill requires t he bureau to ensure all PACE programs and organizations meet the quality and performance standards established by CMS and the bureau. The bureau must oversee and monitor the PACE programs and organizations based upon data and reports that must be periodically submitt ed by PACE organizations to CMS and the bureau. Existing PACE Program If a PACE program exists in Hamilton C ounty, this bill authorizes the service area of the program to expand into contiguous Meigs, Rhea, and Bradley counties. Annual Report On or before January 1 each year, this bill requires the bureau to provide a PACE program report to the speaker of the house of representatives, speaker of the senate, and chair s of legislative committee s having jurisdiction over finance-related matters. Rulemaking This bill authorizes t he director to promulgate rules to effectuate this bill.