Bill Text: NY A09542 | 2021-2022 | General Assembly | Introduced

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Bill Title: Establishes a state-level program of all-inclusive care for the elderly for persons 55 years of age or older, qualifying for nursing home levels of care who wish to remain in their community.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Passed) 2022-12-28 - approval memo.94 [A09542 Detail]

Download: New_York-2021-A09542-Introduced.html

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                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.