CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 540

Introduced by Assembly Member Petrie-Norris

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 introduced, 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 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. The bill would require, in areas where a PACE plan is available, that the PACE plan be presented as an enrollment option in the same manner as other 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.
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 beneficiary who is enrolled in a PACE organization with a contract with the department pursuant to this chapter is exempt from mandatory or passive enrollment in a Medi-Cal managed care plan.
(b) In areas where a PACE plan is available, the PACE plan shall be presented as an enrollment option in the same manner as other managed care plan options, included in all enrollment materials, enrollment assistance programs, and outreach programs, and made available to beneficiaries whenever enrollment choices and options are presented. Outreach and enrollment materials shall enable 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.
(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.
(d) 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 beneficiaries who appear to be eligible for PACE based on age, condition, functional impairment, and use of services.
(e) 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 shall provide information about how they can receive additional information and be assessed for PACE eligibility.