Sec. 3. Two-way PACE program agreements
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Section 1894(a)(4) of the Social Security Act ( 42 U.S.C. 1395eee(a)(4) ) is amended by adding at the end the following new sentence: Beginning January 1, 2022, with respect to a PACE provider operating in a State that has not entered into an agreement described in the previous sentence as of such date, such term shall include an agreement, consistent with this section and regulations promulgated to carry out this section, between such a PACE provider and the Secretary for the operation of a PACE program in such State by the provider under this section alone. .
Section 1934 of the Social Security Act ( 42 U.S.C. 1396u–4 ) is amended— in subsection (a)(4), by adding at the end the following new sentence: Beginning January 1, 2022, with respect to a PACE provider operating in a State that has not entered into an agreement described in the previous sentence as of such date, such term shall include an agreement, consistent with section 1894 and regulations promulgated to carry out such section, between such a PACE provider and the Secretary for the operation of a PACE program in such State by the provider under such section 1894 alone. ; and by adding at the end the following new subsection:
In the case of a State described in the second sentence of subsection (a)(4), the Secretary shall administer the preceding provisions of this section with respect to PACE programs offered by PACE providers under PACE program agreements described in such sentence to PACE program eligible individuals who are eligible for benefits under part A, or enrolled under part B, of title XVIII. For purposes of the administration of this section pursuant to this subsection, the determination under subsection (a)(5)(B) of whether an individual requires the level of care required under the State plan for coverage of nursing facility services shall be made by an independent entity based on a level of care assessment tool used by the State to determine whether an individual requires such level of care.
In this subsection, the term independent entity means an entity with demonstrated professional knowledge to identify institutional level of care needs that— is not the PACE provider operating the PACE program involved; is not owned or controlled by, or an employee of, such PACE provider; does not receive any differential payment (such as a bonus) for identifying individuals who are PACE program eligible individuals under the PACE program agreement involved; and is free of any other conflict of interest (as defined by the Secretary) between the entity and the PACE provider operating the PACE program involved. .
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- 42 USC 1396u–4
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