PACE PROGRAM REIMBURSEMENT METHODOLOGY

(a)In this section and Sections 32.0533 and 32.0534, "PACE…#

(a) In this section and Sections 32.0533 and 32.0534, "PACE program" means the program of all-inclusive care for the elderly (PACE) established under Section 32.053 .

(b)In setting the reimbursement rates under the PACE…#

(b) In setting the reimbursement rates under the PACE program, the executive commissioner shall ensure that:

(1) reimbursement rates for providers under the program are adequate to sustain the program; and

(2) the program is cost-neutral or costs less when compared to the cost to serve a population in the STAR + PLUS Medicaid managed care program that is comparable in:

(A) age;

(B) eligibility factors, including:

(i)income level;#

(i) income level;

PACE PROGRAM REIMBURSEMENT METHODOLOGY

Official source

(a)In this section and Sections 32.0533 and 32.0534, "PACE…#

(a) In this section and Sections 32.0533 and 32.0534, "PACE program" means the program of all-inclusive care for the elderly (PACE) established under Section 32.053 .

(b)In setting the reimbursement rates under the PACE…#

(b) In setting the reimbursement rates under the PACE program, the executive commissioner shall ensure that:

(1) reimbursement rates for providers under the program are adequate to sustain the program; and

(2) the program is cost-neutral or costs less when compared to the cost to serve a population in the STAR + PLUS Medicaid managed care program that is comparable in:

(A) age;

(B) eligibility factors, including:

(i)income level;#

(i) income level;

(ii)

health status; and

#

(ii) health status; and

(iii) impairment level;

(C) geographic location;

(D) living environment; and

(E) other factors determined to be necessary.

(c) For purposes of Subsection (b)(2), the commission shall consider data on the cost of services provided to comparable recipients enrolled in the STAR + PLUS Medicaid managed care program to calculate the upper payment limit component of the PACE program reimbursement rates. The cost of those services includes the Medicaid capitation payment per recipient and Medicaid payments made on a fee-for-service basis for services not covered by the capitation payment. Added by Acts 2015, 84th Leg., R.S., Ch. 823 (H.B. 3823 ), Sec. 1, eff. June 17, 2015.