BILL ANALYSIS
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THIRD READING
Bill No: AB 577
Author: Bonnie Lowenthal (D)
Amended: 8/31/09 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 6/17/09
AYES: Alquist, Strickland, Aanestad, Cox, DeSaulnier,
Leno, Maldonado, Pavley, Wolk
NO VOTE RECORDED: Cedillo, Negrete McLeod
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 73-0, 5/14/09 (Consent) - See last page
for vote
SUBJECT : Program of All-Inclusive Care for the Elderly
SOURCE : Author
DIGEST : This bill authorizes specified state departments
to apply approved exemption requests of a Program of
All-Inclusive Care for the Elderly (PACE) to all locations
of a PACE organization, modifies the exemption for PACE
that may be granted under existing law to require the
exemption to be from duplicative, conflicting or
inconsistent requirements, and prohibits specific federal
requirements of the PACE model from being waived.
Senate Floor Amendments of 8/31/09 deleted a provision of
the bill that author would authorize the Department of
CONTINUED
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Health Care Services (DHCS) to apply approved exemption
requests to all locations of a PACE organization, or to all
PACE organizations on a statewide basis.
ANALYSIS :
Existing law:
1. Permits the Director of DHCS to establish PACE to
promote the development of community-based, risk-based
capitated, long-term care programs. The Director is
allowed to contract with up to ten demonstration
projects to develop risk-based long-term care pilot
programs modeled upon On Lok Senior Health Services in
San Francisco. PACE program benefits are Medi-Cal
benefits under existing law, subject to utilization
controls and eligibility criteria that require that the
beneficiary be certified as eligible for nursing
facility services based on Medi-Cal criteria.
2. Permits DHCS, and as applicable, the Department of Aging
(DOA) and the Department of Social Services (DSS), to
grant to a PACE program exemptions from the provisions
contained in the clinic licensing law, the community
care facilities law, the residential care facilities for
the elderly law, the adult day health centers (ADHC)
law, the home health agencies law, and regulations
governing Medi-Cal and health facilities, including home
health agencies, clinics, and adult day health care
centers. These exemptions can include the use of
alternate concepts, methods, procedures, techniques,
space, equipment, personnel, personnel qualifications,
or the conducting of pilot projects, provided the
exemptions are implemented in a manner that does not
jeopardize the health and welfare of participants
receiving services under PACE, or deprive beneficiaries
of rights in federal or state laws or regulations.
3. Permits a PACE program to submit a single request for an
exemption from licensing requirements that is applicable
to two or more licenses held by that organization, so
long as the request lists the locations and license
numbers held by that organization, and the requested
exemption is the same and appropriate for all licensed
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locations.
This bill:
1. Modifies the exemption authority allowed under existing
law for PACE programs from specified state statutory and
regulatory requirements to require the exemption to be
from duplicative, conflicting or inconsistent
requirements.
2. Prohibits specified federal requirements of the PACE
model from being waived or modified, including all of
the following:
A. The focus on frail elderly qualifying
individuals who require the level of care provided
in a nursing facility.
B. The delivery of comprehensive, integrated acute
and long-term care services.
C. The interdisciplinary team approach to care
management and service delivery.
D. Capitated, integrated financing that allows the
provider to pool payments received from public and
private programs and individuals.
E. The assumption by the provider of full
financial risk.
F. The provision of a PACE benefit package for all
participants, regardless of source of payment,
that includes all Medicare-covered items and
services, all Medicaid-covered items and services,
as specified in the state's Medicaid plan, and
other services determined necessary by the
interdisciplinary team to improve and maintain the
participant's overall health status.
3. Permits a written request that is required to be
submitted by a PACE organization as part of an exemption
request to include a description of how the applicable
state requirement duplicates state or federal
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requirements related to the PACE model. Under current
law, the required description must include how the
applicable state requirement conflicts with, or is
inconsistent with, state or federal requirements related
to the PACE model.
Background
PACE is a capitated benefit provided primarily to certain
Medi-Cal and Medicare beneficiaries that offers a
comprehensive service delivery system and integrates
Medicare and Medicaid financing. The program was modeled
after the acute and long-term care services of On Lok
Senior Health Services in San Francisco.
Participants must be at least 55 years old, live in the
PACE service area, and be certified as eligible for nursing
home care. Enrollment in PACE is voluntary. An
interdisciplinary team, consisting of professional and
paraprofessional staff, assesses participants' needs,
develops care plans, and delivers all services (including
acute care services and when necessary, nursing facility
services). The PACE service package must include all
Medicare and Medicaid covered services, and other services
determined necessary by the interdisciplinary team for the
care of the PACE participant. PACE providers assume full
financial risk for participants' care without limits on
amount, duration, or scope of services.
Existing state law allows up to 10 approved PACE providers.
There are currently five approved PACE organizations in
parts of eight counties in California. The governor's
2009-10 budget estimates average monthly enrollment in PACE
statewide to be 35,043, and projects total capitation
payments to PACE plans of $152.8 million ($76 million GF).
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 9/1/09)
Aging Services of California
Contra Costa County Advisory Council on Aging
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ARGUMENTS IN SUPPORT : PACE programs write in support
that this bill is a technical clean-up bill in response to
AB 847 (Berg), Chapter 315, Statutes of 2005 that would
give state departments the authority to resolve regulatory
conflicts and decrease inefficiency in the oversight of
PACE by allowing exemption requests to apply statewide and
program-wide.
ASSEMBLY FLOOR :
AYES: Adams, Anderson, Arambula, Beall, Bill Berryhill,
Tom Berryhill, Blakeslee, Block, Blumenfield, Brownley,
Buchanan, Caballero, Charles Calderon, Carter, Chesbro,
Conway, Cook, Coto, Davis, De La Torre, De Leon, DeVore,
Duvall, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuller, Furutani, Galgiani, Gilmore, Hagman, Hall,
Harkey, Hayashi, Hernandez, Hill, Huber, Huffman,
Jeffries, Jones, Knight, Krekorian, Lieu, Logue, Bonnie
Lowenthal, Ma, Mendoza, Miller, Monning, Nava, Nestande,
Niello, Nielsen, John A. Perez, V. Manuel Perez,
Portantino, Price, Ruskin, Salas, Silva, Skinner,
Solorio, Audra Strickland, Swanson, Torlakson, Torres,
Torrico, Tran, Villines, Yamada
NO VOTE RECORDED: Ammiano, Fuentes, Gaines, Garrick,
Saldana, Smyth, Bass
CTW:DLW:do 9/1/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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