Today's Law As Amended


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AB-540 Program of All-Inclusive Care for the Elderly.(2021-2022)



As Amends the Law Today


SECTION 1.

 Section 14595 is added to the Welfare and Institutions Code, to read:

14595.
 (a) A Medi-Cal beneficiary who is enrolled in a PACE organization with a contract with the department pursuant to this chapter shall be exempt from mandatory or passive enrollment in a Medi-Cal managed care plan.
(b) Any person enrolled in a PACE plan shall receive all Medicare and Medi-Cal services from the PACE program pursuant to the three-way agreement between the PACE program, the department, and the federal Centers for Medicare and Medicaid Services.
(c) (1) In areas where a PACE plan is available, the PACE plan shall be presented as a Medi-Cal managed care plan enrollment option in the same manner as other Medi-Cal managed care plan enrollment options, included in all enrollment materials, enrollment assistance programs, and outreach programs, and made available to Medi-Cal beneficiaries whenever Medi-Cal managed care plan enrollment choices and options are presented. Outreach and enrollment materials shall enable Medi-Cal beneficiaries to understand what PACE provides, that, if eligible, they may be assessed for PACE eligibility and enroll in PACE, and how they can receive additional information and request to be assessed for PACE eligibility. Persons meeting the age qualifications for PACE and who choose PACE shall not be assigned to a managed care health plan for the lesser of 60 days or until they are assessed for eligibility for PACE and determined to be ineligible for a PACE plan.
(2) In areas of the state where a presentation on Medi-Cal managed care plan enrollment options is unavailable, the department, or its contracted vendor, shall provide outreach and enrollment materials to enable Medi-Cal beneficiaries to understand what PACE provides, that, if eligible, they may be assessed for PACE eligibility and enroll in PACE, and how they can receive additional information and request to be assessed for PACE eligibility.
(d) (1) As part of the Medi-Cal managed care enrollment process for dual eligible beneficiaries, seniors, and persons with disabilities, the department shall establish a system to identify Medi-Cal beneficiaries who appear to be eligible for PACE based on age, residence, and prior use of services. The department, or the state’s enrollment broker, shall conduct outreach to the identified Medi-Cal beneficiaries, and shall provide a referral to PACE if a Medi-Cal beneficiary indicates interest in being assessed for PACE eligibility. If a Medi-Cal beneficiary is identified as potentially meeting the eligibility requirements for PACE, and they indicate interest in being assessed for PACE eligibility, that person shall not be assigned to a managed care health plan for the lesser of 60 days or until they are assessed for eligibility for PACE and determined to be ineligible for a PACE plan.
(2) In areas of the state where there is not a Medi-Cal managed care enrollment process, the department shall establish a system to identify Medi-Cal beneficiaries who appear to be eligible for PACE based on age, residence, and prior use of services. The department, or the state’s enrollment broker, shall conduct outreach to the identified Medi-Cal beneficiaries, and shall provide a referral to PACE if a Medi-Cal beneficiary indicates interest in being assessed for PACE eligibility.
(e) Health plan risk stratification and health risk assessment processes completed by Medi-Cal managed care plans shall include criteria to identify Medi-Cal beneficiaries who appear to be eligible for PACE based on age, condition, functional impairment, and use of services. Identified Medi-Cal beneficiaries shall be provided with the option to be assessed for PACE.
(f) In areas where a PACE plan is available, PACE shall be identified and presented as a Medicare plan option in any mailings or notices to dual eligible beneficiaries regarding their options to enroll in a Medicare plan. These mailings or notices shall provide information about how those Medi-Cal beneficiaries can receive additional information and be assessed for PACE eligibility.