BILL ANALYSIS Ó
AB 471
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Date of Hearing: May 1, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 471 (Atkins) - As Introduced: February 19, 2013
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill deletes the current limitation for the Department of
Health Care Services (DHCS) to enter into up to 15 contracts for
implementation of the Program of All-Inclusive Care for the
Elderly (PACE), and in so doing, authorizes an unlimited number
of contracts.
FISCAL EFFECT
Potential DHCS workload increase if and when the number of
potential PACE programs exceeds the current limit of 15. There
are six PACE programs operating now and five more seeking
approval. It is unlikely this bill's authority would result in
any costs until at least 2014-15 or 2015-16, and initial costs
at that time would likely be less than $150,000. Actual amounts
could be higher or lower depending on demand, with potential for
cost increases or decreases attributable to health care costs as
beneficiaries transition to PACE.
COMMENTS
1)Rationale . According to CalPACE, the sponsor, this bill is
needed to remove the cap on the number of PACE programs with
which DHCS can contract so that PACE is able to scale up to
meet the growing demand for PACE services by frail seniors.
CalPACE also notes the PACE model is consistent with the
state's goal of expanding models of integrated care for
seniors and people with disabilities (SPDs).
2)Background . PACE programs are comprehensive community-based
care models for frail, chronically ill older adults whose
significant functional and cognitive impairments make them
AB 471
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nursing home eligible. The first PACE program, On Lok,
started in the Chinatown section of San Francisco in 1971.
Begun as an alternative to nursing home care in the Chinese
community, where institutionalization was a culturally
unacceptable option, On Lok was a day health center where
older adults could receive health care supervision, social
services, and hot meals, then return to their own homes in the
evening. In 1979, On Lok launched a Medicare-funded
demonstration of the consolidated model of long-term care. In
this model, the program's interdisciplinary team develops,
coordinates, and provides all medical and social services for
participants. In 1997, PACE became a permanent provider type
under both Medicare and Medicaid.
3)Prior legislation . AB 574 (Bonnie Lowenthal), Chapter 367,
Statues of 2011, increased the PACE limit from 10 to the
current 15 and updated statutes to reflect PACE's status
change from a demonstration project to a Medi-Cal optional
benefit.
AB 2206 (Atkins) of 2011 would have facilitated transition to
PACE for a person enrolled in a managed care plan as part of a
DHCS demonstration project who subsequently becomes eligible
for PACE. AB 2206 was vetoed by the governor, who noted
California's role in pioneering the PACE model and stated he
signed AB 574 to expand PACE.
The governor's approach to integrated care, which is part of a
federal waiver, is the Coordinated Care Initiative (CCI) for
people who qualify for both the Medi-Cal and Medicare
programs. The governor intends for managed care plans to
break down the silos that currently exist between medical care
and long-term care. Within this effort, there will be ample
opportunity for PACE to continue its mission and thrive as a
model of care and the Governor said his administration will
involve PACE providers as the initiative rolls out.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081