§ 2999-s. Definitions. For purposes of this article, the following definitions apply: 1. “PACE organization” means an entity as defined in 42 U.S.C. § 1395(eee) and established in accordance with federal public law 105-33, subtitle I of title IV of the Balanced Budget Act of 1997, and licensed or otherwise authorized to operate under this […]
§ 2999-t. Program established. 1. The program of all-inclusive care of the elderly is established in the department to provide community-based, risk-based, and capitated long-term care services as optional services under Medicaid and, where applicable, under Medicare, as well as under contracts among CMS, the department and PACE organizations. 2. A PACE organization operating at […]
§ 2999-u. Licensure. 1. The commissioner shall license an entity applying for licensure as a PACE organization if the applicant demonstrates to the satisfaction of the commissioner that the applicant will: (a) comply with the requirements of a PACE organization under applicable federal law and regulations; (b) provide a facility or facilities at which primary […]
§ 2999-v. Eligibility and enrollment. 1. To be eligible to enroll in a PACE organization, an individual shall: (a) (i) be at least fifty-five years old; (ii) meet the eligibility requirements for a nursing home level of care; (iii) reside within the PACE organization’s approved service area; (iv) be able to be maintained safely in […]
§ 2999-w. Benefits. 1. A PACE organization shall provide the following benefits to its enrollees: (a) all benefits under Medicaid, including under section three hundred sixty-four-j of the social services law; (b) all benefits under Medicare, for enrollees that are enrolled in Medicare; and (c) other services determined necessary by the PACE organization’s interdisciplinary team […]
§ 2999-x. Reimbursement. 1. The commissioner shall develop and implement, consistent with applicable federal requirements, reimbursement rates and methodologies for Medicaid services provided by a PACE organization to its enrollees. 2. The commissioner shall provide, or shall require any independent actuary used to review PACE reimbursement rates to provide, to PACE organizations the documents and […]
§ 2999-y. Regulations and applicable laws. 1. The commissioner shall make regulations and take other actions reasonably necessary to implement this article, including the establishment of any rules and processes appropriate for the safe, efficient and orderly administration of the program and for the maintenance and revocation of licensure under this article. 2. (a) Licensure […]
