Bill Text: CA AB577 | 2009-2010 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Program of All-Inclusive Care for the Elderly.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2009-10-11 - Chaptered by Secretary of State - Chapter 456, Statutes of 2009. [AB577 Detail]

Download: California-2009-AB577-Amended.html

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BILL NUMBER: AB 577	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 13, 2009

INTRODUCED BY   Assembly Member Bonnie Lowenthal

                        FEBRUARY 25, 2009

   An act to amend  Section 1580.1   Sections
1580.1 and 100315  of the Health and Safety Code, and to amend
Sections 14590  and 14591   , 14591, and 14598
 of the Welfare and Institutions Code, relating to the elderly.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 577, as amended, Bonnie Lowenthal. Program for All-Inclusive
Care for the Elderly.
   Existing law establishes the federal Medicaid program,
administered by each state, California's version of which is the
Medi-Cal program. The Medi-Cal program, which is administered by the
State Department of Health Care Services under the direction of the
Director of Health Care Services, provides qualified low-income
persons with health care services.
   Existing federal law establishes the Programs of All-Inclusive
Care for the Elderly (PACE), which provides specified services for
older individuals so that they may continue living in the community.
Federal law permits states to implement the PACE program as a
Medicaid state option.
   Existing state law authorizes the director to establish the
California Program of All-Inclusive Care for the Elderly, and to
contract with up to 10 demonstration projects to develop risk-based
long-term care pilot programs, and establishes PACE program services
as a covered benefit of the Medi-Cal program.
   Existing law authorizes the State Department of Health Care
Services, and as applicable, the California Department of Aging, to
grant exemptions to entities contracting with the department under
the PACE program from certain provisions relating to adult day health
centers. 
   This bill would authorize the department to grant exemptions that
it has granted to a PACE program pursuant to the above provisions on
a statewide basis as appropriate or to a PACE organization on an
organization-wide basis in instances when an exemption for a single
license is expanded to other locations.  
   This bill specifies that certain federal requirements of the PACE
model not be waived or modified, including the interdisciplinary team
approach to care management and service delivery. This bill provides
that the PACE benefit package for all participants, regardless of
source of payment, shall include 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. 
   This bill would  also  make technical, nonsubstantive
changes to the above provisions.
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1580.1 of the Health and Safety Code is amended
to read:
   1580.1.  The State Department of Health Care Services, and as
applicable, the California Department of Aging, may grant to entities
contracting with the State Department of Health Care Services under
the PACE program, as defined in Chapter 8.75 (commencing with Section
14590) of Part 3 of Division 9 of the Welfare and Institutions Code,
exemptions from the provisions contained in this chapter in
accordance with the requirements of Section 100315.
   SEC. 2.    Section 100315 of the   Health
and Safety Code   is amended to read: 
   100315.  (a) The department and as applicable, the California
Department of Aging and the State Department of Social Services, may
grant to a PACE program, as defined in Chapter 8.75 (commencing with
Section 14590) of Part 3 of Division 9 of the Welfare and
Institutions Code, exemptions from  duplicative, conflicting, or
inconsistent requirements, or from  the provisions contained in
Chapter 1 (commencing with Section 1200), Chapter 3 (commencing with
Section 1500), Chapter 3.2 (commencing with Section 1569), Chapter
3.3 (commencing with Section 1570), and Chapter 8 (commencing with
Section 1725) of Division 2, and Divisions 3 and 5 of Title 22 of the
California Code of Regulations, including the use of alternate
concepts, methods, procedures, techniques, space, equipment,
personnel, personnel qualifications, or the conducting of pilot
projects, provided that 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
specified in federal or state laws or regulations. In determining
whether to grant exemptions under this section, the departments shall
consult with each other. 
   (b) The department may grant exemptions that it granted to a PACE
program pursuant to paragraph (a) on a statewide basis as appropriate
or to a PACE organization on an organization-wide basis in instances
when an exemption for a single license is expanded to other
locations.  
   (b) 
    (c)  A written request and substantiating evidence
supporting the request for an exemption under subdivision (a) shall
be submitted by the PACE program to the department. A PACE program
may submit a single request for an exemption from the licensing
requirements 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 locations. The written request
shall include, but shall not be limited to, all of the following:
   (1) A description of how the applicable state requirement 
duplicates,  conflicts with  ,  or is inconsistent with
state or federal requirements related to the PACE model.
   (2) An analysis demonstrating why the  duplication, 
conflict  ,  or inconsistency cannot be resolved without an
exemption.
   (3) A description of how the PACE program plans to comply with the
intent of the requirements described in paragraph (1).
   (4) A description of how the PACE program will monitor its
compliance with the terms and conditions under which the exemption is
granted. 
   (c) 
    (d)  The department shall approve or deny any request
within 60 days of submission. An approval shall be in writing and
shall provide for the terms and conditions under which the exemption
is granted. A denial shall be in writing and shall specify the basis
therefor. Any decision to deny a request shall be a final
administrative decision. 
   (d) 
    (e)  If, after investigation, the department determines
that a PACE program that has been granted an exemption under this
section is operating in a manner contrary to the terms and conditions
of the exemption, the department shall immediately suspend or revoke
the exemption. If the exemption is applicable to more than one
location or more than one category of licensure, or both, the
department may suspend or revoke an exemption as to one or more
license categories or locations as deemed appropriate by the
department.
   SEC. 2.   SEC. 3.   Section 14590 of the
Welfare and Institutions Code is amended to read:
   14590.  The Legislature finds and declares that:
   (1) Community-based services to the frail elderly are often
uncoordinated, fragmented, inappropriate, or insufficient to meet the
needs of frail elderly who are at risk of institutionalization,
often resulting in unnecessary placement in nursing homes.
   (2) Steadily increasing health care costs for the frail elderly
provide incentive to develop programs providing quality services at
reasonable costs.
   (3) Capitated "risk-based" financing provides an alternative to
the traditional fee-for-service payment system by providing a fixed,
per capita monthly payment for a package of health care services and
requiring the provider to assume financial responsibility for cost
overruns.
   (4) On Lok Senior Health Services began as a federal and state
demonstration program in 1973 to test whether comprehensive
community-based services could be provided to the frail elderly at no
greater cost than nursing home care.
   (5) Since 1983, On Lok Senior Health Services of San Francisco has
successfully provided a comprehensive package of services and
operated within a cost-effective, capitated risk-based financing
system.
   (6) Recognizing On Lok's success, Congress passed Legislation in
1986 and 1987 encouraging the expansion of capitated long-term care
programs by permitting federal Medicare and Medicaid waivers to be
granted indefinitely to On Lok and authorizing the federal Centers
for Medicare and Medicaid Services to grant waivers in up to 10 new
sites throughout the nation in order to replicate the On Lok model.
   (7) In California, numerous agencies have expressed interest in
developing programs similar to On Lok and will need the cooperation
of the State Department of Health Care Services to successfully
obtain the necessary available federal waivers to develop risk-based
capitated long-term care demonstration programs.
   (8) Through the development of these demonstration programs, the
viability of a cost-effective statewide program offering quality
long-term care services can be evaluated.
   (9) To achieve maximum cost effectiveness in demonstration
projects under this chapter, an expedited contract process is
necessary.
   SEC. 3.   SEC. 4.   Section 14591 of the
Welfare and Institutions Code is amended to read:
   14591.  The State Director of Health Care Services may establish
the California Program of All-Inclusive Care for the Elderly, to
promote the development of community-based, risk-based capitated,
long-term care programs.
   SEC. 5.    Section 14598 of the   Welfare
and Institutions Code   is amended to read: 
   14598.  (a) The Legislature finds and declares both of the
following:
   (1) The demonstration projects authorized by this article have
proven to be successful at providing comprehensive, community-based
services to frail elderly individuals at no greater cost than for
providing nursing home care.
   (2) Based upon that success, California now desires to provide
community-based, risk-based, and capitated long-term care services
under the Programs of All-Inclusive Care for the Elderly (PACE) as
optional services under California's medicaid state plan and under
contracts, entered into between the federal Centers for Medicare and
Medicaid Services, the department, as the single state medicaid
agency, and PACE organizations, meeting the requirements of the
Balanced Budget Act of 1997 (Public Law 105-33) and Part 460
(commencing with Section 460.2) of Subchapter E of Title 42 of the
Code of Federal Regulations.
   (b) The department may enter into the contracts specified in
subdivision (a) for implementation of the PACE program, and also may
enter into separate contracts with the PACE organizations contracting
under subdivision (a), to fully implement the single state agency
responsibilities assumed by the department in those contracts, the
provisions of Section 14132.94, and any other state requirement found
necessary by the department to provide comprehensive
community-based, risk-based, and capitated long-term care services to
California's frail elderly. The department may enter into separate
contracts specified in subdivision (a) with up to 10 PACE
organizations. The department may not enter into any contracts
specified in subdivision (a) unless a medicaid state plan amendment,
electing PACE as a state medicaid option as provided for in Section
14132.94, has been approved by the federal Centers for Medicare and
Medicaid Services.
   (c) Notwithstanding subdivisions (a) and (b), any demonstration
project contract entered into under this article prior to January 1,
2004, shall remain in full force and effect under its own terms, but
shall not be renewed or amended beyond the termination date in effect
on that date. 
   (d) The requirements of the PACE model, as provided for pursuant
to Section 1894 (42 U.S.C. Sec. 1395eee) and Section 1934 (42 U.S.C.
Sec. 1396u-4) of the federal Social Security Act, shall not be waived
or modified. The requirements that shall not be waived or modified
include all of the following:  
   (1) The focus on frail elderly qualifying individuals who require
the level of care provided in a nursing facility.  
   (2) The delivery of comprehensive, integrated acute and long-term
care services.  
   (3) The interdisciplinary team approach to care management and
service delivery.  
   (4) Capitated, integrated financing that allows the provider to
pool payments received from public and private programs and
individuals.  
   (5) The assumption by the provider of full financial risk. 

   (e) The PACE benefit package for all participants, regardless of
source of payment, shall include all of the following:  
   (1) All Medicare-covered items and services.  
   (2) All Medicaid-covered items and services, as specified in the
state's Medicaid plan.  
   (3) Other services determined necessary by the interdisciplinary
team to improve and maintain the participant's overall health status.
 
   (d) 
    (f)  For purposes of this section, "PACE organizations"
means those entities as defined in 42 C.F.R. 460.6.