BILL ANALYSIS �
AB 2206
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Date of Hearing: May 2, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 2206 (Atkins) - As Introduced: February 23, 2012
Policy Committee: HealthVote:19-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Department of Health Care Services, in
their implementation of specified pilot projects that provide
coordinated care to individuals dually eligible for Medicaid and
Medicare, to present a Program of All-Inclusive Care for the
Elderly (PACE) plan as an enrollment option if there is a PACE
plan available.
FISCAL EFFECT
Required enrollee notification costs should be minor and
absorbable.
COMMENTS
1)Rationale . The author indicates PACE is a proven model of care
for frail seniors on Medi-Cal and Medicare. Studies show that
enrollment in PACE is associated with several beneficial
outcomes, including fewer hospitalizations and nursing home
admissions and improved quality of life. In spite of this,
experience with the enrollment of the seniors and the special
needs population into managed care left the PACE programs out
of the marketing materials sent by the state to potential
enrollees. PACE programs had to send separate mailings to a
population that is by definition frail, resulting in enrollee
confusion. The contractors that worked with the state to
provide informational seminars and call centers were not
trained in the availability of PACE as an option or how to
refer interested enrollees to a PACE program.
2)PACE . PACE programs are a comprehensive, community-based model
of care for frail, chronically ill older adults whose
AB 2206
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significant functional and cognitive impairments make them
nursing home-eligible. The first PACE program, On Lok, which
was started in the Chinatown section of San Francisco in 1971,
eventually evolved into a nationally recognized and replicated
model of integrated care and services. PACE programs receive a
capitated (per member per month) payment from Medicare and
Medicaid, and are fully at risk for all inpatient, outpatient,
and nursing home care that a PACE enrollee requires. PACE
programs also provide other support services such as adult day
care, meals, home care, transportation, and social services.
DHCS currently contracts with five PACE programs throughout
the state, and reports that five additional organizations in
California are in various stages of development of new PACE
programs.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081