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F I S C A L I M P A C T R E P O R T
SPONSOR Feldman
ORIGINAL DATE
LAST UPDATED
02/16/07
HB
SHORT TITLE All-Inclusive Elderly Care Enrollment Growth
SB 997
ANALYST Weber
APPROPRIATION (dollars in thousands)
Appropriation
Recurring
or Non-Rec
Fund
Affected
FY07
FY08
$500.0
Recurring
General
(Parenthesis ( ) Indicate Expenditure Decreases)
Duplicates HB 1075 Relates to Appropriation in the General Appropriation Act
REVENUE (dollars in thousands)
Estimated Revenue
Recurring
or Non-Rec
Fund
Affected
FY07
FY08
FY09
$1,240.0
Recurring
Federal
Medicaid
(Parenthesis ( ) Indicate Revenue Decreases)
SOURCES OF INFORMATION
LFC Files
Responses Received From
Human Services Department (HSD)
Aging and Long Term Services Department
SUMMARY
Synopsis of Bill
Senate Bill 997 appropriates $500 thousand from the general fund to the Human Services
Department for the purpose of expanding enrollment in the all inclusive care for the elderly
program in Albuquerque.
pg_0002
Senate Bill 997 – Page
2
FISCAL IMPLICATIONS
The appropriation of $500 thousand contained in this bill is a recurring expense to the general
fund. Any unexpended or unencumbered balance remaining at the end of Fiscal Year 2008 shall
revert to the general fund.
SIGNIFICANT ISSUES
ALTSD reports that the Program of All-inclusive Care for the Elderly (PACE) in New Mexico
has one approved provider, Total Community Care (TCC). The PACE model was developed to
address the needs of long-term care clients, providers and payers. The program features a
comprehensive service delivery system and integrated Medicare and Medicaid financing. The
PACE provider receives monthly Medicare and Medicaid capitation payments for each eligible
enrollee. The PACE provider assumes full financial risk for participants' care without limits on
amount, duration or scope of services.
The PACE program currently provides services to 309 participants. The Program is limited in its
ability to grow to three (3) new enrollees per month as long as one (1) of the three (3) is a
nursing home reintegration client. TCC has successfully re-introduced 23 nursing home
residents into the community over a 25 month period. The monthly cost for a Medicaid eligible
individual to be placed in a nursing home is $4,098. If it becomes necessary for an individual
who participates in the PACE program to be institutionalized, regardless of the length of stay, the
PACE program assumes financial responsibility for the individual's placement and continues to
receive the monthly Medicaid capitation rate of $2,442.08. Due to Medicaid cost containment
strategies, a waiting list is now maintained by TCC for those waiting to receive services from the
PACE program. Twenty (20) individuals who were on this waiting list were institutionalized
due to non receipt of medically necessary long term care services. The monthly institutional
Medicaid cost for these 20 individuals is $81,960 ($4,098 monthly nursing home cost for 20
individuals), compared to the monthly PACE cost of $48,840 ($2,442.08 monthly PACE
capitated rate for 20 individuals).
This appropriation allows the PACE program to increase the growth of the program from three
(3) to six (6) enrollees per month. Enabling the enrollment to increase from three (3) to six (6)
per month, allows the total enrollment to reach nearly 400 enrollees. A census of 400 is
sufficient to expand to a second site. This would also allow the PACE program to reduce the
current wait list of 140 applicants.
Total Community Care (TCC) is experiencing census growth in the Northwest Albuquerque
area, the city of Rio Rancho, Bernalillo and Placitas. Currently, PACE has 82 existing enrollees
residing in this area and approximately 44 individuals residing in these geographic locations are
on the waiting list for PACE services. These geographic locations create difficulty in providing
efficient transportation services due to the distance from the current site and the limited access
across the Rio Grande River for those locations west of the river. The City of Rio Rancho is the
fastest growing city in New Mexico. Rio Rancho Economic Development has projected the
population in the year 2010 to be 81,793 residents. The new PACE site could potentially serve
an additional 200+ participants. The new site would also be a more efficient and effective way
to serve the participants who are currently residing in the Rio Rancho area who are being
transported to the current site for services.
MW/mt