BILL ANALYSIS Ó
AB 574
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Date of Hearing: April 12, 2011
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Mariko Yamada, Chair
AB 574 (Lowenthal) - As Amended: March 23, 2011
SUBJECT : Program of All-Inclusive Care for the Elderly.
SUMMARY : Amends the Welfare and Institutions Codes to give the
Department of Health Care Services (DHCS) power to authorize ten
additional Program for All Inclusive Care for the Elderly (PACE)
sites, bringing the new maximum number of authorized sites to
20, and updates the codes pertaining to that program by
eliminating outdated references to the PACE program.
Specifically, this bill :
1)Removes language authorizing the PACE program as a
demonstration project in the state of California, with
authorization for 10 PACE sites.
2)Retains the PACE program as a permanent state program.
3)Makes various findings and declarations with regard to
justifications for making PACE a permanent state program,
including that as demonstration projects, PACE has
successfully provided comprehensive community-based services
to frail elderly Californians at no greater cost than
providing nursing home care.
4)Allows for the long-term implementation of the PACE model in
California.
5)Alters the number of sites by increasing the limit of
providers from 10 to 20.
EXISTING LAW
1)Establishes the Medicare program under the United States
Social Security Act of 1965, which provides for health care
services to qualified older or disabled individuals.
2)Establishes the Medi-Cal program, the California version of
the federal Medicaid program authorized through Title XIX of
the Social Security Act, and provides access to healthcare and
healthcare services for qualified low-income/low-asset
individuals.
3)Establishes the Program for All-Inclusive Care for the Elderly
AB 574
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(PACE) demonstration projects which combine resources from
both the Medicaid and Medicare programs to provide a
comprehensive medical/social service delivery system using an
interdisciplinary team approach in a center that provides and
coordinates all needed preventive, primary, acute and
long-term care services.
4)Authorizes ten (10) PACE demonstration projects within
specific geographical boundaries within California to develop
risk-based, capitated long-term care pilot programs, and
covers those services as an optional Medi-Cal benefit.
5)Establishes DHCS Office of Long-Term Care as the oversight
entity for PACE programs in California and outlines the
administration and regulation of the programs.
6)Authorizes DHCS, and other state departments as applicable, to
provide exemptions from existing regulations, and the
authority to conduct pilot projects, provided that the
exemptions are implemented in a manner that does not
jeopardize the health and welfare of participants, or deprive
beneficiaries of rights specified in federal or state laws or
regulations..
7)Allows DHCS to immediately suspend or revoke an exemption if
after investigation the department determines that a PACE
program that has been granted an exemption is operating in a
manner contrary to the terms and conditions of the exemption.
FISCAL EFFECT : Unknown
COMMENTS :
According to the Author's statement; "AB 574 allows for the
long-term implementation of the PACE model in California by
increasing the limit of providers from 10 to 20. In addition,
AB 574 modernizes state statute relative to the PACE programs by
deleting out-dated references to its prior status as a federal
demonstration program. With this bill, we can ensure that
California law reflects the current status and program standards
of the PACE model and continue to expand the availability of
PACE statewide."
In order to participate in a PACE program, a person must be 55
years of age or older, meet the requirement for skilled nursing
home care as determined by the PACE organization's
interdisciplinary team assessment, lives in a service area
(county and zip code) served by a PACE program, and can live in
the community without jeopardizing his or her health or safety.
AB 574
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For individuals who are Medi-Cal eligible, the program pays for
a portion of the monthly PACE premium. Medicare pays for the
rest. If a person does not qualify for Medi-Cal, he/she is
responsible for the portion of the monthly premium Medi-Cal
would pay.
Each day, the PACE program provides transportation to the day
health center. Transportation is a key part of the PACE
benefit. Transportation is not only provided between the home
and the day health center, but also to appointments with
specialists and other activities.
There are five PACE sites operating in California presently.
1. Altamed Senior BuenaCare Los Angeles County
2. Center for Elders Independence Alameda County
3. On Lok SeniorHealth San Francisco County
4. Sutter Seniorcare Sacramento County
5. Community ElderCare of San Diego San Diego County
REGISTERED SUPPORT / OPPOSITION :
Support
AltaMed Health Services Corporation
California Hospital Association (CHA)
CalPACE
On Lok
St. Paul's PACE
Opposition
None on file.
Analysis Prepared by : Robert MacLaughlin / AGING & L.T.C. /
(916) 319-3990