BILL NUMBER: AB 574 INTRODUCED
BILL TEXT
INTRODUCED BY Assembly Member Bonnie Lowenthal
FEBRUARY 16, 2011
An act to amend Section 14598 of the Welfare and Institutions
Code, relating to the elderly.
LEGISLATIVE COUNSEL'S DIGEST
AB 574, as introduced, Bonnie Lowenthal. Program of All-Inclusive
Care for the Elderly.
Existing law establishes the federal Medicaid program,
administered by each state, California's version of which is the
Medi-Cal program. The Medi-Cal program, which is administered by the
State Department of Health Care Services under the direction of the
Director of Health Care Services, provides qualified low-income
persons with health care services. Existing federal law establishes
the Program of All-Inclusive Care for the Elderly (PACE), which
provides specified services for older individuals so that they may
continue living in the community. Federal law authorizes states to
implement the PACE program as a Medicaid state option.
Existing state law authorizes the director to establish the
California Program of All-Inclusive Care for the Elderly and
establishes PACE program services as a covered benefit of the
Medi-Cal program. Existing law authorizes the department to enter
into specified contracts for implementation of the PACE program, and
also enter into separate contracts with certain PACE organizations,
to fully implement the single state agency responsibilities assumed
by the department, as specified. Existing law authorizes the
department to enter into separate contracts with up to 10 PACE
organizations, but prohibits certain contracts unless a Medicaid
state plan amendment, electing PACE as a state Medicaid option, has
been approved by the federal Centers for Medicare and Medicaid
Services.
This bill would increase to 20 the number of authorized separate
contracts.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 14598 of the Welfare and Institutions Code is
amended to read:
14598. (a) The Legislature finds and declares both of the
following:
(1) The demonstration projects authorized by this article have
proven to be successful at providing comprehensive, community-based
services to frail elderly individuals at no greater cost than for
providing nursing home care.
(2) Based upon that success, California now desires to provide
community-based, risk-based, and capitated long-term care services
under the Programs of All-Inclusive Care for the Elderly (PACE) as
optional services under California's Medicaid state plan and under
contracts, entered into between the federal Centers for Medicare and
Medicaid Services, the department, as the single state medicaid
agency, and PACE organizations, meeting the requirements of the
Balanced Budget Act of 1997 (P.L. 105-33) and Part 460 (commencing
with Section 460.2) of Subchapter E of Chapter IV of Title 42 of the
Code of Federal Regulations.
(b) The department may enter into the contracts specified in
subdivision (a) for implementation of the PACE program, and also may
enter into separate contracts with the PACE organizations contracting
under subdivision (a), to fully implement the single state agency
responsibilities assumed by the department in those contracts,
Section 14132.94, and any other state requirement found necessary by
the department to provide comprehensive community-based, risk-based,
and capitated long-term care services to California's frail elderly.
The department may enter into separate contracts specified in
subdivision (a) with up to 10 20 PACE
organizations. The department may not enter into any contracts
specified in subdivision (a) unless a Medicaid state plan amendment,
electing PACE as a state Medicaid option as provided for in Section
14132.94, has been approved by the federal Centers for Medicare and
Medicaid Services.
(c) Notwithstanding subdivisions (a) and (b), any demonstration
project contract entered into under this article prior to January 1,
2004, shall remain in full force and effect under its own terms, but
shall not be renewed or amended beyond the termination date in effect
on that date.
(d) The requirements of the PACE model, as provided for pursuant
to Section 1894 (42 U.S.C. Sec. 1395eee) and Section 1934 (42 U.S.C.
Sec. 1396u-4) of the federal Social Security Act, shall not be waived
or modified. The requirements that shall not be waived or modified
include all of the following:
(1) The focus on frail elderly qualifying individuals who require
the level of care provided in a nursing facility.
(2) The delivery of comprehensive, integrated acute and long-term
care services.
(3) The interdisciplinary team approach to care management and
service delivery.
(4) Capitated, integrated financing that allows the provider to
pool payments received from public and private programs and
individuals.
(5) The assumption by the provider of full financial risk.
(6) The provision of a PACE benefit package for all participants,
regardless of source of payment, that shall include all of the
following:
(A) All Medicare-covered items and services.
(B) All Medicaid-covered items and services, as specified in the
state's Medicaid plan.
(C) Other services determined necessary by the interdisciplinary
team to improve and maintain the participant's overall health status.
(e) For purposes of this section, "PACE organizations" means those
entities as defined in Section 460.6 of Title 42 of the Code of
Federal Regulations.