BILL ANALYSIS
AB 577
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 577 (Bonnie Lowenthal)
As Amended August 31, 2009
Majority vote
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|ASSEMBLY: |73-0 |(May 14, 2009) |SENATE: |35-0 |(September 2, |
| | | | | |2009) |
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Original Committee Reference: AGING & L.T.C.
SUMMARY : Allows the Department of Health Care Services (DHCS)
to grant exemptions from duplicative requirements to Program of
All-Inclusive Care for the Elderly (PACE) providers.
Specifically, this bill :
1)Allows DHCS, and as applicable the California Department of
Aging, the State Department of Public Health (DPH), and the
State Department of Social Services, to grant exemptions from
duplicative, conflicting, or inconsistent requirements to a
PACE program.
2)Specifies that the requirements of the PACE model, as provided
under federal law, shall not be 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;
and,
f) The provision of a PACE benefit package for all
participants, regardless of source of payment, to include
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all of the following:
i) All Medicare-covered items and services;
ii) All Medicaid-covered items and services, as
specified in the state's Medicaid plan; and,
iii) Other services determined necessary by the
interdisciplinary team to improve and maintain the
participant's overall health status.
3)Makes additional, technical changes to existing law.
The Senate amendments add DPH to the list of departments
authorized to grant exemptions to the PACE requirements, and
delete the language allowing DHCS to grant statewide exemptions
to PACE providers.
AS PASSED BY THE ASSEMBLY , this bill authorized DHCS and other
state departments to grant licensing exemptions to PACE programs
on an organization-wide or statewide basis in order to reduce
duplication and conflicts between various programmatic and
licensure requirements under existing law. In addition, this
bill specified the requirements of the PACE model, in conformity
with federal law.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS : PACE is an integrated model of care delivery serving
older adults in need of nursing home care with a broad range and
intense coordination of services. PACE is funded through
capitation payments from Medicare, Medicaid and private
individuals depending on the individual's eligibility for public
programs. Program staff provide direct health care to
participants as well as arrange for additional services through
other contracted providers. PACE programs, under the direct
oversight by the Centers for Medicare and Medicaid Services and
the Medi-Cal program, also hold multiple state licenses for
clinics, adult day health care and home health agency services.
In some areas, the integrated nature of PACE services results in
conflicts between federal and state rules.
Under existing state law, PACE programs must operate at least
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one PACE center. Each center is licensed as both an adult day
health care program and a community clinic. In addition, PACE
programs directly providing skilled nursing services in the home
must be licensed as a home health agency. On Lok Senior Health
Services, which operates multiple centers, must maintain 17
separate licenses to serve over 900 enrollees.
California's five existing PACE programs must comply with a
myriad of regulatory requirements due to the model's integration
of Medicare and Medicaid financing and services, its
categorization as both a health plan and provider, and oversight
from four different state departments. Some requirements result
in duplication that is unduly burdensome and costly for PACE
providers, inefficient for state and federal regulators and adds
no benefit or special protection to the consumer. Other
requirements are conflicting and inappropriate for PACE
organizations or are inconsistent with federal or other state
rules that are specially adapted to the PACE model.
In 2005, AB 847 (Berg), Chapter 315, Statutes of 2005, provided
DHCS and other state departments to grant exemptions to existing
regulations for PACE programs in instances where DHCS finds that
the licensing requirements do not fit the PACE model and that
granting the exemption does not jeopardize the health and
welfare of participants in the PACE Program. This bill provides
additional clarification to the exemption process and allows
DCHS to grant exemptions on a statewide or organization-wide
basis in addition to the individual program exemptions allowed
under current law.
Analysis Prepared by : Allison Ruff / AGING & L.T.C. / (916)
319-3990
FN: 0002765