Amended  IN  Assembly  May 03, 2021
Amended  IN  Assembly  March 29, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 523

Introduced by Assembly Member Nazarian

February 10, 2021

An act to add Section 14593.3 to the Welfare and Institutions Code, relating to the elderly.


LEGISLATIVE COUNSEL'S DIGEST


AB 523, as amended, Nazarian. 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, as 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, and authorizes the State Department of Health Care Services to implement the PACE program by various means, including letters, or other similar instructions, without taking regulatory action. Under this authority, the department implemented various guidance on the PACE program in response to the state of emergency caused by the 2019 novel coronavirus (COVID-19). (COVID-19), including authorizing a PACE organization to deliver prescribed services, including medically necessary services through telehealth. Existing law authorizes the department to enter into contracts with various entities to implement the PACE program and fully implement the single state agency responsibilities assumed by the department pursuant to those contracts, as specified.
This bill would generally require the department to make permanent the specified PACE program flexibilities instituted, on or before January 1, 2021, in response to the state of emergency caused by COVID-19 by means of all-facility letters or other similar instructions taken without regulatory action. action, with prescribed modifications, such as instead limiting a PACE organization’s use of telehealth to specified services, including conducting assessments for eligibility for enrollment in the PACE program, subject to the federal waiver process. The bill would require the department to work with the federal Centers for Medicare and Medicaid Services to determine how to extend PACE program flexibilities approved during the COVID-19 emergency.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 Section 14593.3 is added to the Welfare and Institutions Code, to read:

14593.3.
 (a) The department shall make permanent the following changes in the California Program of All-Inclusive Care for the Elderly (PACE) program the department instituted, on or before January 1, 2021, in response to the state of emergency caused by the 2019 novel coronavirus (COVID-19) by means of all-facility letters, or other similar instructions, which were taken without regulatory action, in the areas described under paragraphs (1) to (7), inclusive. inclusive:
(1) (A) Telehealth.

(B)Medically necessary services may be delivered by a PACE organization via an in-person visit or telehealth, as deemed appropriate by the PACE organization. A PACE organization shall seek to implement any telehealth method that would provide remote consultation as an alternate means of providing critical, medically necessary services.

(B) A PACE organization may use telehealth, as defined in Section 2290.5 of the Business and Professions Code, to conduct assessments for eligibility for enrollment in the PACE program, or for service modifications, subject to the federal waiver process.
(2) (A) PACE enrollment agreements.
(B) A PACE organization shall be approved to collect and document a verbal agreement of enrollment in lieu of the participant signature normally required to complete the enrollment agreement for the PACE program. A PACE organization shall document the conversation of the verbal agreement. agreement and shall obtain a written signature within 14 days of submission of the enrollment agreement.
(3) (A) Adult Day Health Care (ADHC) services provided in the home.
(B) A PACE organization shall not be required to provide all services at the center, and nursing services, as defined in Section 14550.6, at the center. The PACE interdisciplinary team shall have flexibility to determine how to provide basic those nursing services to participants. Services may be provided via telehealth or other remote methods, including, but not limited to, check-in calls, health screening calls, video conferencing, and meal delivery. and video conferencing, taking into account the participant’s medical, physical, emotional, and social needs.

(C)For purposes of subparagraph (B), “basic services” includes all of the following:

(i)Medical services.

(ii)Nursing services.

(iii)Nutrition services.

(iv)Occupational therapy.

(v)Physical therapy.

(vi)Psychiatric or psychological services.

(vii)Recreation or planned social activities.

(viii)Social services.

(ix)Speech therapy.

(4) (A) Involuntary disenrollments – Out of Service Area.
(B) A As part of a plan of care, a PACE organization shall not be required to submit a involuntary disenrollment request for a participant that has temporarily moved out of the service area. A The location of the temporary move shall be within a ____ minute drive of the PACE center and shall not exceed a 30-day period unless extenuating circumstances exist. During a temporary move, as described in this subparagraph, a PACE participant shall not be required to update their address with the county Medi-Cal office to ensure their continued enrollment in the PACE organization. A PACE organization shall retain responsibility for coordination of care and services and full financial risk. risk in alignment with federal regulations.
(5) (A) Facility beds.
(B) A As part of a plan of care, a PACE organization shall have the flexibility to place a participant in a facility that is out of their approved service area if there is a lack of available beds in the PACE organization’s service area. A The location of the temporary placement shall be within a ____ minute drive of the PACE center and shall not exceed a 30-day period unless extenuating circumstances exist. During a temporary placement, as described in this subparagraph, a PACE organization shall retain responsibility for coordination of care and services and full financial risk. risk in alignment with federal regulations.
(6) (A) Marketing.
(B) A PACE organization shall have the flexibility to use a broker for marketing purposes as provided by the federal regulations on PACE. A PACE organization may use individuals and entities to market on their behalf, if the individuals or entities have been appropriately trained on PACE program requirements, and, specifically, participant rights, and requirements on participant enrollment and disenrollment.
(7) (A) Discharge planning.
(B) If a discharge planner at a PACE referral source, including, but not limited to, a hospital, emergency room, nursing home, or health plan, determines that a PACE plan would be an appropriate program to facilitate the patient’s discharge and serve the patient’s needs in their home or community, the discharge planner may ask the patient or the patient’s representative if they would prefer to be contacted by a PACE organization. If the patient affirmatively answers, then all of the following apply:
(i) The discharge planner shall document in the patient’s record that the patient or authorized representative consented to be contacted by a PACE organization.
(ii) The discharge planner may inform the PACE organization that the patient consented to being contacted by a PACE organization, and may provide information on how the patient or representative stated they wish to be contacted.
(iii) The PACE organization may directly contact the patient or representative in the manner chosen by the patient or representative. The PACE organization may make one attempt to contact the patient or their representative by various means, including a phone call, email, or mail. If the individual or their representative indicates that the patient is uninterested in the PACE program or does not respond, the PACE organization shall not make further direct contact.
(b) The department shall work with the federal Centers for Medicare and Medicaid Services to determine how to extend PACE program flexibilities approved during the COVID-19 emergency.