Bill Text: NY A04137 | 2023-2024 | General Assembly | Introduced

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Bill Title: Clarifies provisions related to a state-level program of all-inclusive care for the elderly.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2023-02-15 - substituted by s855 [A04137 Detail]

Download: New_York-2023-A04137-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          4137

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                    February 10, 2023
                                       ___________

        Introduced by M. of A. ARDILA -- 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); and to amend a  chapter  of
          the  laws  of  2022  amending  the  public  health law relating to the
          program of all-inclusive care for the elderly (PACE), as  proposed  in
          legislative bills numbers S. 8903 and A. 9542, in relation to legisla-
          tive intent

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Section 1 of a chapter of the laws  of  2022  amending  the
     2  public  health law relating to the program of all-inclusive care for the
     3  elderly (PACE), as proposed in legislative bills numbers S. 8903 and  A.
     4  9542, is amended to read as follows:
     5    Section  1.  Legislative intent. The Program of All-Inclusive Care for
     6  the Elderly ("PACE") is a federally recognized  model  of  comprehensive
     7  care  for  persons 55 years of age or older who qualify for nursing home
     8  levels of care, who wish to remain  in  their  community,  and  who  are
     9  eligible for Medicaid (see, Sections 1894 and 1934 to Title XVIII of the
    10  Social  Security  Act;  42  CFR  460).  Uniformity of regulation of PACE
    11  organizations will promote efficiency for the organizations and for  the
    12  state. It is the intent of the legislature through this act to provide a
    13  more  efficient and uniform structure to promote the prudent development
    14  of PACE organizations, to promote better health outcomes for New Yorkers
    15  enrolled in PACE organizations, and to realize administrative  efficien-
    16  cies.  It  is  the intent of the legislature to recognize PACE organiza-
    17  tions as integrated providers of care.  PACE organizations shall not  be
    18  construed  to  be  managed  care  organizations  under article 44 of the
    19  public health law, provided however that this  shall  not  prohibit  the
    20  application of requirements under such article or other applicable laws,
    21  or  similar  requirements, as determined appropriate by the commissioner

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD04216-01-3
        A. 4137                             2

     1  of health or superintendent of insurance pursuant to regulations promul-
     2  gated by the commissioner under this act.
     3    §  2. Sections 2999-u, 2999-v, 2999-w, 2999-x and 2999-y of the public
     4  health law, as added by a chapter of  the  laws  of  2022  amending  the
     5  public  health law relating to the program of all-inclusive care for the
     6  elderly (PACE), as proposed in legislative bills numbers S. 8903 and  A.
     7  9542, are amended to read as follows:
     8    §  2999-u.  Licensure.  1.  The  commissioner  shall license an entity
     9  applying for licensure as a PACE organization if the [entity]  applicant
    10  demonstrates  to the satisfaction of the commissioner that the applicant
    11  will:
    12    (a) [complies] comply with the requirements  of  a  PACE  organization
    13  under applicable federal law and regulations;
    14    (b)  [provides] provide a facility or facilities at which primary care
    15  and other services are furnished to enrollees;
    16    (c) [provides] provide an  interdisciplinary  team  approach  to  care
    17  management, care delivery and care planning;
    18    (d)  [complies] comply with this article, the applicable provisions of
    19  articles twenty-eight, thirty-six and forty-four  of  this  chapter  and
    20  regulations  thereunder,  and regulations of the commissioner under this
    21  article; and
    22    (e) [enters] enter into a PACE  organization  contract  and  agreement
    23  with the department and CMS.
    24    2.  (a) [A PACE organization shall comply with applicable requirements
    25  of articles forty-four, thirty-six and twenty-eight of this chapter.
    26    (b)] A PACE organization shall serve an  approved  geographic  service
    27  area.
    28    [(c)]  (b) A PACE organization and its incorporators, directors, spon-
    29  sors, stockholders, members, and operators shall  have  the  experience,
    30  competence,  and  standing in the community as to give reasonable assur-
    31  ance of their ability to operate the organization to provide a  consist-
    32  ently  high  level of care for enrollees and comply with this article. A
    33  PACE organization shall demonstrate that where any incorporator,  direc-
    34  tor,  sponsor,  stockholder,  member,  or  operator  of the organization
    35  holds, or within the past seven years has held, a  controlling  interest
    36  or  been  a  controlling  person in an organization or facility licensed
    37  under this chapter, a consistently high level of care has been  rendered
    38  in each such organization or facility.
    39    [(d)]  (c)  A  PACE organization shall meet requirements for financial
    40  solvency under paragraph (c) of subdivision one  of  section  forty-four
    41  hundred  three  of this chapter, including a contingent reserve require-
    42  ment which may, by regulations of the commissioner,  be  different  from
    43  that required by that paragraph.
    44    [(e)]  (d)  A PACE organization shall be deemed to be a health mainte-
    45  nance organization under article forty-four of this chapter[, but  sole-
    46  ly]  for purposes of subdivision one of section sixty-five hundred twen-
    47  ty-seven of the education law.
    48    3. (a) The commissioner shall establish in regulation a unified licen-
    49  sure process for PACE organizations that includes the applicable program
    50  requirements of this article and articles twenty-eight,  thirty-six  and
    51  forty-four of this chapter.
    52    (b)  A license under this article shall require approval of the public
    53  health and health planning council.
    54    § 2999-v. Eligibility and enrollment. 1. To be eligible to enroll in a
    55  PACE organization, an individual shall:
    56    (a) (i) be at least fifty-five years old; [and
        A. 4137                             3

     1    (b)] (ii) meet the eligibility requirements for a nursing  home  level
     2  of care; [and
     3    (c)]  (iii)  reside  within  the  PACE organization's approved service
     4  area; [and
     5    (d)] (iv) be able to  be  maintained  safely  in  the  community-based
     6  setting with the assistance of the PACE organization; [or (e)] and
     7    (v)  meet  any  additional  program  specific  eligibility  conditions
     8  imposed under the PACE program agreement between the PACE  organization,
     9  the department, and CMS; or
    10    (b)  be  otherwise  eligible to participate in a PACE demonstration or
    11  specialty program authorized by the  federal  PACE  Innovation  Act  and
    12  approved by the department and CMS.
    13    2. Enrollment in a PACE organization shall be voluntary for the eligi-
    14  ble individual.
    15    § 2999-w. Benefits. 1. A PACE organization shall provide the following
    16  benefits to its enrollees:
    17    (a) all benefits under Medicaid, including under section three hundred
    18  sixty-four-j of the social services law;
    19    (b)  all  benefits  under Medicare, for enrollees that are enrolled in
    20  Medicare; and
    21    (c) other services determined necessary  by  the  PACE  organization's
    22  interdisciplinary  team  to  improve and maintain the enrollee's overall
    23  health status.
    24    2. A PACE organization may provide  fiscal  intermediary  services  if
    25  approved under section three hundred sixty-five-f of the social services
    26  law.
    27    §  2999-x. Reimbursement. 1. The commissioner shall develop and imple-
    28  ment, consistent with  applicable  federal  requirements,  reimbursement
    29  rates  and methodologies for Medicaid services provided by a PACE organ-
    30  ization to its enrollees.
    31    2. The commissioner shall provide, or shall  require  any  independent
    32  actuary  used  to  review  PACE  reimbursement rates to provide, to PACE
    33  organizations the documents and information [regarding  PACE  reimburse-
    34  ment rates submitted to CMS in a form and timeframe] consistent with the
    35  requirements  [for  providing  or  causing  to be provided documents and
    36  information to Medicaid managed care providers] under paragraph  (c)  of
    37  subdivision eighteen of section three hundred sixty-four-j of the social
    38  services law.
    39    §  2999-y. Regulations and applicable laws. 1.  The commissioner shall
    40  make regulations and take other actions reasonably necessary  to  imple-
    41  ment  this  article,  including the establishment of any rules and proc-
    42  esses appropriate for the safe, efficient and orderly administration  of
    43  the  program  and  for the maintenance and revocation of licensure under
    44  this article.
    45    2. [The commissioner shall develop and implement a unified process for
    46  PACE organizations to complete reports, submit  to  audits,  respond  to
    47  surveys,  and provide other information, including maximizing conformity
    48  with federal requirements] (a) Licensure granted under this article may,
    49  in accordance with the approval by the commissioner,  entitle  the  PACE
    50  organization  to  act  in  the  capacity and perform the activities of a
    51  diagnostic and treatment center, home care services agency, health main-
    52  tenance organization, or managed long term care plan for which licensure
    53  or certification is otherwise required under article twenty-eight, thir-
    54  ty-six, or forty-four of this chapter as applicable without  such  sepa-
    55  rate license or certification for purposes relating to the PACE.
        A. 4137                             4

     1    (b)  To  the extent that a PACE organization is acting in the capacity
     2  or performing an activity for which licensure or certification is other-
     3  wise required under article twenty-eight, thirty-six, or  forty-four  of
     4  this  chapter,  the  PACE  organization shall comply with the applicable
     5  requirements  of  such  articles  and any applicable regulations adopted
     6  thereunder; except that where such requirements  are  inconsistent  with
     7  the  requirements  of this article or regulations adopted by the commis-
     8  sioner under this article, the requirements of  this  article  and  such
     9  regulations shall apply.
    10    3.  The  commissioner  may apply for federal waivers under Medicaid or
    11  demonstration programs under Medicare  relating  to  the  PACE  program,
    12  provided  that  the waiver or demonstration shall not diminish any right
    13  or benefit of enrollees under this article.
    14    § 3. This act shall take effect on the  same  date  and  in  the  same
    15  manner  as  a chapter of the laws of 2022 amending the public health law
    16  relating to the program of all-inclusive care for the elderly (PACE), as
    17  proposed in legislative bills numbers S. 8903 and A. 9542, takes effect.