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hb750_01_RH
As Reported by the House Health Committee
136th
General Assembly
Regular
Session
Am. H. B. No. 750
2025-2026
Representatives Roemer, White, A.
Cosponsor: Representative Schmidt
To
amend section 173.503 and to repeal section 173.502 of the Revised
Code
regarding
site expansion and timely enrollment for the Program of All-Inclusive
Care for the Elderly (PACE).
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section
1.
That
section 173.503 of the Revised Code be amended to read as follows:
Sec.
173.503.
The
department of aging shall seek to implement a presumptive eligibility
component to the PACE program, under which applicants for PACE may
receive services under the program during a temporary period, to
begin immediately upon application and a finding of presumptive
eligibility, while a PACE organization conducts a full eligibility
determination on behalf of the individual.
If
the individual is determined to be ineligible for PACE, the PACE
organization that found the individual presumptively eligible shall
be responsible for the costs of PACE services provided to the
individual during the presumptive eligibility period.
A
PACE organization may enroll an individual in PACE on the first day
of the month following the date the individual applied for PACE and
begin providing PACE services to the individual before the
individual's medicaid application has been approved, if the
department of aging has determined that the individual meets all
other PACE eligibility requirements. If the individual is found to be
medicaid eligible, the department of medicaid shall reimburse the
PACE organization for PACE services provided to the individual by the
organization, beginning on the date the individual was enrolled in
PACE under this section. If the individual is determined to be
ineligible for medicaid, the PACE organization shall assume financial
responsibility for the length of the individual's enrollment in PACE.
The PACE organization may request the individual pay the private pay
rate for PACE services. If the participant chooses not to pay the
private pay rate, the PACE organization may follow the department of
aging's involuntary disenrollment requirements to disenroll the
individual.
Section
2.
That
existing section 173.503 of the Revised Code is hereby repealed.
Section
3.
That
section 173.502 of the Revised Code is hereby repealed.
Section
4.
(A)
As used in this section:
(1)
"CMS" means the United States Centers for Medicare and
Medicaid Services.
(2)
"Entity" has the same meaning as in 42 C.F.R. 460.10.
(3)
"PACE center," "PACE organization,"
"participant," and "state administering agency"
have the same meanings as in 42 C.F.R. 460.6.
(B)(1)
Not later December 31, 2026, the Department of Aging shall issue a
request for proposals from any entity interested in becoming a PACE
organization located in a county of this state not served by the PACE
program on the effective date of this section. Proposals shall be
submitted to the Department not later than ninety days after the date
the Department issues the request for proposals.
(2)
Division (B)(1) of this section does not prevent the Department from
expanding the PACE program outside of the process required by that
division, including by issuing other requests for proposals. All
rates for new PACE organizations added on or after the effective date
of this section by a request for proposal shall be the same as for
PACE organizations in existence on that date.
(C)
To be eligible for approval by the Department to become a PACE
organization, an entity that submits a proposal pursuant to division
(B)(1) of this section shall meet all of the following requirements:
(1)
The entity provides a feasibility study of its proposed service area
to the Department.
(2)
The entity has a current, valid provider agreement, as defined in
section 5164.01 of the Revised Code, or will be eligible to enter
into a provider agreement by the time that the entity will begin
providing services under the PACE program.
(3)
The entity meets all federal requirements applicable to PACE
organizations.
(4)
The entity demonstrates to the satisfaction of the Department that
the organization has experience providing health care services to
frail older adults and that each member of the entity's staff,
including employees and contractors, complies with 42 C.F.R. 460.64.
(5)
The entity has a facility suitable to be a PACE center, or plans to
acquire, build, or expand a facility suitable to be a PACE center
prior to beginning services, in its proposed service area, as
described in the request for proposals process.
(6)
The entity meets any additional requirements in rules adopted by the
Department pursuant to division (G) of this section.
(D)
The Department shall review all proposals submitted in accordance
with division (B)(1) of this section. The Department shall determine
from the proposals which entities it considers qualified to become
PACE organizations for each service area. The determination shall be
made not later than June 30, 2027.
(E)
An entity considered by the Department as qualified to become a PACE
organization may apply to CMS to become a PACE organization. The
Department shall provide support to any such organization that
applies to CMS by complying with federal requirements.
(F)
Each entity approved to become a PACE organization by CMS shall begin
providing services to participants not later than two years after the
entity receives notice of its approval from CMS, consistent with
federal financial participation.
(G)
The Director of Aging may adopt rules to implement this section. The
rules shall be adopted in accordance with Chapter 119. of the Revised
Code.