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 pursuant to those contracts, as specified. Existing law establishes the State Department of Public Health and sets forth its powers and duties, including, but not limited to, duties relating to the licensing and regulation of various entities, including primary care clinics, adult day health care centers, and home health agencies. This bill would exempt from licensure by the State Department of Public Health a primary care clinic, an adult day health care center, or a home health agency, that is approved by the State Department of Health Care Services to operate exclusively as part of a PACE organization or that provides services to individuals who are being assessed for eligibility to enroll in the PACE program for not more than 60 calendar days after an individual submits an application for enrollment. The bill would instead subject those entities to oversight and regulation by the State Department of Health Care Services. The bill would require those entities to comply with the operating standards described in their respective provisions, except as modified by the State Department of Health Care Services, to meet the needs of PACE participants or those individuals being assessed. The bill would require those entities to apply for licensure with the State Department of Public Health if they provide services to any other individuals, as specified. The bill would repeal related provisions as part of conforming changes. The bill would condition the transfer of powers between the 2 departments on the Director of Health Care Services determining, and communicating that determination in writing to the State Department of Public Health, that operating standards compliance programs have been established. The bill would require those PACE organizations to cooperate with the State Department of Health Care Services by providing the department with requested records or information or with access to inspect physical locations. The bill would authorize the department to refuse to enter into, or to terminate, a contract with a noncompliant or noncooperative PACE organization, or to require that PACE organization to submit a corrective action plan to bring it into compliance, as specified. The bill would authorize the department to enter into contracts, or to amend existing contracts, on a bid or negotiated basis, to implement these provisions, and would authorize the department to implement, interpret, or make specific these provisions by means of letters, bulletins, or other similar instructions, without taking regulatory action. The bill would require the department to implement these provisions no later than January 1, 2021, but only to the extent any necessary federal approvals are obtained and federal financial participation is available. The bill would require the department to establish an administrative fee to be paid by each of those PACE organizations, as specified, in an amount necessary to pay for reasonable costs of implementing and administering these provisions. The bill would create a special fund, the PACE Oversight Fund of the State Department of Health Care Services, for the deposit of the fees, to be expended upon appropriation by the Legislature. This bill would incorporate additional changes to Section 1206 of the Health and Safety Code proposed by AB 1037 to be operative only if this bill and AB 1037 are enacted and this bill is enacted last.