New York State Assembly

 
•  Summary 
 
•  Actions 
 
•  Committee Votes 
 
•  Floor Votes 
 
•  Memo 
 
•  Text 
 
•  LFIN 
 
•  Chamber Video/Transcript 

A09542 Summary:

A09542 Actions:

A09542 Committee Votes:

Committee:HEALTH   Chair:Gottfried      
DATE:04/26/2022AYE/NAY:26/0  Action: Favorable         
Gottfried
Aye
Byrne
Aye
Galef
Aye
McDonough
Aye
Dinowitz
Aye
Byrnes
Aye
Cahill
Aye
Ashby
Aye
Paulin
Aye
Salka
Aye
Cymbrowitz
Aye
Jensen
Aye
Gunther
Aye
Gandolfo
Aye
Rosenthal L 
Aye
Hevesi
Aye
Steck
Aye
Abinanti
Aye
Braunstein
Aye
Solages
Aye
Bichotte Hermel
Aye
Sayegh
Aye
Rosenthal D 
Aye
McDonald
Aye
Reyes
Aye
Gonzalez-Rojas
Aye

A09542 Floor Votes:

A09542 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A9542
 
SPONSOR: Gottfried

 
TITLE OF BILL:
 
An act to amend the public health law, in relation to the program of
all-inclusive care for the elderly (PACE)
 
 
PURPOSE OR GENERAL IDEA OF BILL:
 
To expand access to a high-quality, interdisciplinary nursing home
alternative model of care for frail, elderly New Yorkers and support
them in the community for as long as possible by establishing a new
licensure and oversight structure for the Program of All-Inclusive Care
for the Elderly ("PACE") programs in New York.
 
 
SUMMARY OF SPECIFIC PROVISIONS:

Section one establishes the legislative findings and intent.
 
Section two amends the public health law by adding a new article 29-EE:
 
2999-s Definitions,
 
2999-t Program established.
 
2999-u Licensure.
 
2999-v Eligibility and enrollment.
 
2999-w Benefits.
 
2999-x Reimbursement.
 
2999-y Regulations.
 
Section three - Severability clause.
 
Section four - Effective Date
 
 
JUSTIFICATION:
 
The Program of All-Inclusive Care for the Elderly ("PACE") is a feder-
ally recognized model of provider-sponsored, comprehensive care for
persons 55 years of age or older who are otherwise eligible for nursing
home admission. The PACE program fully integrates, coordinates, and pays
for the continuum of Medicare and Medicaid covered services to enable
individuals with long-term care needs to live safely in the community.
PACE programs directly provide medical care, home health care, and
social support services (typically at a PACE Center), unlike partially
capitated managed long-term care (MLTC) plans that only provide certain
Medicaid-covered long-term services and supports.
 
PACE programs provide over 5,000 New Yorkers with opportunity to remain
safely in their communities and improve their quality of life, while
also effectively controlling health care expenditures.  Nationwide, PACE
participants have shown reduced hospitalizations, readmissions, reliance
on emergency medical services, along with improved quality of life and
higher satisfaction with their care.  Yet, New York pays PACE programs
less than the cost of caring for a comparable population through other
Medicaid services, including nursing homes and home and MLTC programs.
 
However, PACE organizations operate in an onerous regulatory environment
which hinders their ability to expand and the further development of
PACE programs in New York.  Statutory reforms are necessary to eliminate
barriers to the development, expansion and efficient operation of PACE
programs in New York while preserving vitally important protections to
those receiving services.
 
Currently, PACE organizations in New York must be licensed as MLTC
plans, clinics, and licensed home care agencies (under Articles 44, 28,
and 36 of New York's Public Health Law, respectively). This has created
an inefficient and administratively burdensome authorization process,
which has limited the expansion of this critical product and does not
reflect their unique role in the healthcare system.
 
This bill seeks to streamline the regulation of PACE programs by devel-
oping a uniform authorization process, encompassing all program require-
ments into a singular licensure, improve oversight of PACE organiza-
tions, and develop a methodology for establishing payment rates for
benefits provided by the PACE program to Medicaid-eligible enrollees.
These changes maintain the same level of oversight of all PACE programs
that exist today across all program areas.

Both nationally and here in New York, PACE programs have demonstrated
the ability to allow individuals to reside safely in their communities
for longer, improve their quality of life and deliver a high satisfac-
tion with their care. Contrary to costing the State money, PACE programs
deliver this desired level of care for elderly individuals for less than
the cost of caring for a comparable population through other Medicaid
services. As we continue to ponder the future of healthcare and the
delivery of long-term services and supports, in light of the lessons
learned during the COVID-19 pandemic, the need to deliver more services
in the community and prevent institutionalization is clear. PACE has
consistently demonstrated the ability to achieve these goals-and expand-
ing the reach of the program will help keep more people in the communi-
ty.
 
 
PRIOR LEGISLATIVE HISTORY:
 
 New Legislation.
 
 
FISCAL IMPLICATIONS:
 
None.
 
 
EFFECTIVE DATE:
This act would take effect on the one hundred eightieth day after it
shall have become a law.

A09542 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          9542
 
                   IN ASSEMBLY
 
                                     March 16, 2022
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED  --  read once and referred to the
          Committee on Health
 
        AN ACT to amend the public health law, in relation  to  the  program  of
          all-inclusive care for the elderly (PACE)
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Legislative intent. The Program of All-Inclusive  Care  for
     2  the  Elderly  ("PACE")  is a federally recognized model of comprehensive
     3  care for persons 55 years of age or older who qualify for  nursing  home
     4  levels  of  care,  who  wish  to  remain in their community, and who are
     5  eligible for Medicaid (see, Sections 1894 and 1934 to Title XVIII of the
     6  Social Security Act; 42 CFR  460).  Uniformity  of  regulation  of  PACE
     7  organizations  will promote efficiency for the organizations and for the
     8  state. It is the intent of the legislature through this act to provide a
     9  more efficient and uniform structure to promote the prudent  development
    10  of PACE organizations, to promote better health outcomes for New Yorkers
    11  enrolled  in PACE organizations, and to realize administrative efficien-
    12  cies. It is the intent of the legislature to  recognize  PACE  organiza-
    13  tions  as integrated providers of care.  PACE organizations shall not be
    14  construed to be managed care  organizations  under  article  44  of  the
    15  public health law.
    16    § 2. The public health law is amended by adding a new article 29-EE to
    17  read as follows:
    18                                ARTICLE 29-EE
    19                PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY
    20  Section 2999-s. Definitions.
    21          2999-t. Program established.
    22          2999-u. Licensure.
    23          2999-v. Eligibility and enrollment.
    24          2999-w. Benefits.
    25          2999-x. Reimbursement.
    26          2999-y. Regulations.
    27    §  2999-s.  Definitions.  For  purposes of this article, the following
    28  definitions apply:

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14903-01-2
        A. 9542                             2
 
     1    1. "PACE organization" means an entity as defined  in  42  U.S.C.    §
     2  1395(eee)  and established in accordance with federal public law 105-33,
     3  subtitle I of title IV of the Balanced Budget Act of 1997, and  licensed
     4  or otherwise authorized to operate under this article.
     5    2.  "Program  of  all-inclusive  care  of  the elderly" or "PACE" is a
     6  federally recognized model of comprehensive care for persons  fifty-five
     7  years of age or older eligible for Medicaid and may also be eligible for
     8  Medicare,  qualifying for nursing home levels of care who wish to remain
     9  in their community (see, Sections 1894 and 1934 to Title  XVIII  of  the
    10  Social Security Act; 42 CFR 460), and established under this article.
    11    3.  "Medicaid"  means  title  eleven  of  article  five  of the social
    12  services law and the program thereunder. "Medicare" means title XVIII of
    13  the federal social security act and the programs thereunder.
    14    4. "CMS" means the federal Centers for Medicare and Medicaid Services.
    15    5. "Enrollee" means an individual enrolled in a PACE organization.
    16    § 2999-t. Program established. 1. The program of all-inclusive care of
    17  the elderly is established in the department to provide community-based,
    18  risk-based, and capitated long-term care services as  optional  services
    19  under  Medicaid  and, where applicable, under Medicare, as well as under
    20  contracts among CMS, the department and PACE organizations.
    21    2. A PACE organization operating at the time this article becomes  law
    22  may  continue  to  operate  while the organization transitions into full
    23  compliance with this article, under a process  and  requirements  estab-
    24  lished by the commissioner.
    25    §  2999-u. Licensure. 1. The commissioner shall license an entity as a
    26  PACE organization if the entity:
    27    (a) complies with the requirements of a PACE organization under appli-
    28  cable federal law and regulations;
    29    (b) provides a facility or facilities at which primary care and  other
    30  services are furnished to enrollees;
    31    (c)  provides  an  interdisciplinary team approach to care management,
    32  care delivery and care planning;
    33    (d) complies with this article and  regulations  of  the  commissioner
    34  under this article; and
    35    (e) enters into a PACE organization contract and agreement with CMS.
    36    2.  (a)  A PACE organization shall comply with applicable requirements
    37  of articles forty-four, thirty-six and twenty-eight of this chapter.
    38    (b) A PACE organization shall serve  an  approved  geographic  service
    39  area.
    40    (c)  A  PACE  organization and its incorporators, directors, sponsors,
    41  stockholders and operators shall have the  experience,  competence,  and
    42  standing in the community as to give reasonable assurance of their abil-
    43  ity  to operate the organization to provide a consistently high level of
    44  care for enrollees and comply with this  article.  A  PACE  organization
    45  shall demonstrate that where any incorporator, director, sponsor, stock-
    46  holder  or  operator of the organization holds, or within the past seven
    47  years has held, a controlling interest or been a controlling  person  in
    48  an  organization or facility licensed under this chapter, a consistently
    49  high level of care has been rendered in each such organization or facil-
    50  ity.
    51    (d) A PACE organization shall meet requirements for financial solvency
    52  under paragraph (c) of subdivision one  of  section  forty-four  hundred
    53  three  of this chapter, including a contingent reserve requirement which
    54  may, by regulations of the commissioner, be different from that required
    55  by that paragraph.
        A. 9542                             3
 
     1    (e) A PACE organization shall be deemed to  be  a  health  maintenance
     2  organization  under  article  forty-four of this chapter, but solely for
     3  purposes of subdivision one of section sixty-five  hundred  twenty-seven
     4  of the education law.
     5    3.  The  commissioner  shall establish a unified licensure process for
     6  PACE organizations that includes the applicable program requirements  of
     7  this article. A license under this article shall require approval of the
     8  public health and health planning council.
     9    § 2999-v. Eligibility and enrollment. 1. To be eligible to enroll in a
    10  PACE organization, an individual shall:
    11    (a) be at least fifty-five years old; and
    12    (b)  meet  the  eligibility  requirements  for a nursing home level of
    13  care; and
    14    (c) reside within the PACE organization's approved service area; and
    15    (d) be able to be maintained safely  in  the  community-based  setting
    16  with the assistance of the PACE organization; or
    17    (e)  be  otherwise  eligible to participate in a PACE demonstration or
    18  specialty program authorized by the  federal  PACE  Innovation  Act  and
    19  approved by CMS.
    20    2. Enrollment in a PACE organization shall be voluntary for the eligi-
    21  ble individual.
    22    § 2999-w. Benefits. 1. A PACE organization shall provide the following
    23  benefits to its enrollees:
    24    (a) all benefits under Medicaid, including under section three hundred
    25  sixty-four-j of the social services law;
    26    (b)  all  benefits  under Medicare, for enrollees that are enrolled in
    27  Medicare; and
    28    (c) other services determined necessary  by  the  PACE  organization's
    29  interdisciplinary  team  to  improve and maintain the enrollee's overall
    30  health status.
    31    2. A PACE organization may provide fiscal intermediary services  under
    32  section three hundred sixty-five-f of the social services law.
    33    §  2999-x. Reimbursement. 1. The commissioner shall develop and imple-
    34  ment, consistent with  applicable  federal  requirements,  reimbursement
    35  rates  and methodologies for Medicaid services provided by a PACE organ-
    36  ization to its enrollees.
    37    2. The commissioner shall provide, or shall  require  any  independent
    38  actuary  used  to  review  PACE  reimbursement rates to provide, to PACE
    39  organizations the documents and information regarding PACE reimbursement
    40  rates submitted to CMS in a  form  and  timeframe  consistent  with  the
    41  requirements  for  providing  or  causing  to  be provided documents and
    42  information to Medicaid managed care providers under  paragraph  (c)  of
    43  subdivision eighteen of section three hundred sixty-four-j of the social
    44  services law.
    45    §  2999-y. Regulations. 1. The commissioner shall make regulations and
    46  take other actions reasonably necessary to implement this article.
    47    2. The commissioner shall develop and implement a unified process  for
    48  PACE  organizations  to  complete  reports, submit to audits, respond to
    49  surveys, and provide other information, including maximizing  conformity
    50  with federal requirements.
    51    3.  The  commissioner  may apply for federal waivers under Medicaid or
    52  demonstration programs under Medicare  relating  to  the  PACE  program,
    53  provided  that  the waiver or demonstration shall not diminish any right
    54  or benefit of enrollees under this article.
    55    § 3. Severability. If any provision of this act, or any application of
    56  any provision of this act, is held to be invalid, or to  violate  or  be
        A. 9542                             4
 
     1  inconsistent  with  any federal law or regulation, that shall not affect
     2  the validity or effectiveness of any other provision of this act  or  of
     3  any  other  application of any provision of this act, which can be given
     4  effect  without  that  provision  or  application;  and to that end, the
     5  provisions and applications of this act are severable.
     6    § 4. This act shall take effect on the one hundred eightieth day after
     7  it shall have become a law. Effective immediately, the  commissioner  of
     8  health  shall  make regulations and take other actions reasonably neces-
     9  sary to implement this act on that date.

A09542 LFIN:

 
NO LFIN

A09542 Chamber Video/Transcript: