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



Current Version: 04/27/21 - Amended Assembly

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AB540:v98#DOCUMENT

Amended  IN  Assembly  April 27, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 540

Introduced by Assembly Member Petrie-Norris
(Coauthors: Assembly Members Aguiar-Curry, Patterson, Quirk-Silva, and Villapudua)

February 10, 2021

An act to add Section 14595 to the Welfare and Institutions Code, relating to the elderly.


LEGISLATIVE COUNSEL'S DIGEST


AB 540, as amended, Petrie-Norris. Program of All-Inclusive Care for the Elderly.
Existing federal law establishes the Program of All-Inclusive Care for the Elderly (PACE), which provides specified services for older individuals at a PACE center, defined, in part, as a facility that includes a primary care clinic, so that they may continue living in the community. Federal law authorizes states to implement the PACE program as a Medicaid state option.
Existing state law establishes the California Program of All-Inclusive Care for the Elderly (PACE program) to provide community-based, risk-based, and capitated long-term care services as optional services under the state’s Medi-Cal State Plan, as specified. Existing law authorizes the State Department of Health Care Services to enter into contracts with various entities for the purpose of implementing the PACE program and fully implementing the single-state agency responsibilities assumed by the department in those contracts, as specified.
This bill would exempt a Medi-Cal beneficiary who is enrolled in a PACE organization with a contract with the department from mandatory or passive enrollment in a Medi-Cal managed care plan. plan, and would require persons enrolled in a PACE plan to receive all Medicare and Medi-Cal services from the PACE program. The bill would require, in areas where a PACE plan is available, that the PACE plan be presented as an a Medi-Cal managed care plan enrollment option in the same manner as other Medi-Cal managed care plan options, as specified. The bill would require the department to establish an auto-referral system to refer to PACE organizations beneficiaries who appear to be eligible for PACE, based on various criteria, including residence, as specified. The bill would also require, among other things, in areas where a PACE plan is available, that PACE be identified and presented as a Medicare plan option, as specified. options. In areas of the state where a presentation on Medi-Cal managed care plan enrollment options is unavailable, the bill would require the department or its contracted vendor to provide outreach and enrollment materials on PACE. The bill would require the department to establish a system to identify Medi-Cal beneficiaries who appear to be eligible for PACE based on age, residence, and prior use of services, and, with respect to that system, would require the department to conduct specified outreach and referrals.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


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 is 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.

(b)

(c) (1) In areas where a PACE plan is available, the PACE plan shall be presented as an a Medi-Cal managed care plan enrollment option in the same manner as other managed care plan Medi-Cal managed care plan enrollment options, included in all enrollment materials, enrollment assistance programs, and outreach programs, and made available to beneficiaries whenever 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 not to be eligible for a PACE plan. Persons 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. to be ineligible for a PACE plan.

(c)As part of the managed care enrollment process for dual eligible beneficiaries, seniors, and persons with disabilities, the department shall establish an autoreferral system to refer to PACE organizations beneficiaries who appear to be eligible for PACE based on age, residence, and prior use of services. Persons meeting the age qualifications for PACE who are auto referred to PACE shall not be assigned to a managed care plan for the lesser of 60 days or until they are assessed for eligibility for PACE and determined not be eligible 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.

(d)

(e) Health plan risk stratification and health risk assessment processes completed by Medi-Cal managed care plans shall include criteria to identify and refer to PACE 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.

(e)

(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 and plan. These mailings or notices shall provide information about how they those Medi-Cal beneficiaries can receive additional information and be assessed for PACE eligibility.