S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9542
 
                           I N  A S S E M B L Y
 
                              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:

   Section 1. Legislative intent. The Program of All-Inclusive  Care  for
 the  Elderly  ("PACE")  is a federally recognized model of comprehensive
 care for persons 55 years of age or older who qualify for  nursing  home
 levels  of  care,  who  wish  to  remain in their community, and who are
 eligible for Medicaid (see, Sections 1894 and 1934 to Title XVIII of the
 Social Security Act; 42 CFR  460).  Uniformity  of  regulation  of  PACE
 organizations  will promote efficiency for the organizations and for the
 state. It is the intent of the legislature through this act to provide a
 more efficient and uniform structure to promote the prudent  development
 of PACE organizations, to promote better health outcomes for New Yorkers
 enrolled  in PACE organizations, and to realize administrative efficien-
 cies. It is the intent of the legislature to  recognize  PACE  organiza-
 tions  as integrated providers of care.  PACE organizations shall not be
 construed to be managed care  organizations  under  article  44  of  the
 public health law.
   § 2. The public health law is amended by adding a new article 29-EE to
 read as follows:
                               ARTICLE 29-EE
               PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY
 SECTION 2999-S. DEFINITIONS.
         2999-T. PROGRAM ESTABLISHED.
         2999-U. LICENSURE.
         2999-V. ELIGIBILITY AND ENROLLMENT.
         2999-W. BENEFITS.
         2999-X. REIMBURSEMENT.
         2999-Y. REGULATIONS.
   §  2999-S.  DEFINITIONS.  FOR  PURPOSES OF THIS ARTICLE, THE FOLLOWING
 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. "PACE ORGANIZATION" MEANS AN ENTITY AS DEFINED  IN  42  U.S.C.    §
 1395(EEE)  AND ESTABLISHED IN ACCORDANCE WITH FEDERAL PUBLIC LAW 105-33,
 SUBTITLE I OF TITLE IV OF THE BALANCED BUDGET ACT OF 1997, AND  LICENSED
 OR OTHERWISE AUTHORIZED TO OPERATE UNDER THIS ARTICLE.
   2.  "PROGRAM  OF  ALL-INCLUSIVE  CARE  OF  THE ELDERLY" OR "PACE" IS A
 FEDERALLY RECOGNIZED MODEL OF COMPREHENSIVE CARE FOR PERSONS  FIFTY-FIVE
 YEARS OF AGE OR OLDER ELIGIBLE FOR MEDICAID AND MAY ALSO BE ELIGIBLE FOR
 MEDICARE,  QUALIFYING FOR NURSING HOME LEVELS OF CARE WHO WISH TO REMAIN
 IN THEIR COMMUNITY (SEE, SECTIONS 1894 AND 1934 TO TITLE  XVIII  OF  THE
 SOCIAL SECURITY ACT; 42 CFR 460), AND ESTABLISHED UNDER THIS ARTICLE.
   3.  "MEDICAID"  MEANS  TITLE  ELEVEN  OF  ARTICLE  FIVE  OF THE SOCIAL
 SERVICES LAW AND THE PROGRAM THEREUNDER. "MEDICARE" MEANS TITLE XVIII OF
 THE FEDERAL SOCIAL SECURITY ACT AND THE PROGRAMS THEREUNDER.
   4. "CMS" MEANS THE FEDERAL CENTERS FOR MEDICARE AND MEDICAID SERVICES.
   5. "ENROLLEE" MEANS AN INDIVIDUAL ENROLLED IN A PACE ORGANIZATION.
   § 2999-T. PROGRAM ESTABLISHED. 1. THE PROGRAM OF ALL-INCLUSIVE CARE OF
 THE ELDERLY IS ESTABLISHED IN THE DEPARTMENT TO PROVIDE COMMUNITY-BASED,
 RISK-BASED, AND CAPITATED LONG-TERM CARE SERVICES AS  OPTIONAL  SERVICES
 UNDER  MEDICAID  AND, WHERE APPLICABLE, UNDER MEDICARE, AS WELL AS UNDER
 CONTRACTS AMONG CMS, THE DEPARTMENT AND PACE ORGANIZATIONS.
   2. A PACE ORGANIZATION OPERATING AT THE TIME THIS ARTICLE BECOMES  LAW
 MAY  CONTINUE  TO  OPERATE  WHILE THE ORGANIZATION TRANSITIONS INTO FULL
 COMPLIANCE WITH THIS ARTICLE, UNDER A PROCESS  AND  REQUIREMENTS  ESTAB-
 LISHED BY THE COMMISSIONER.
   §  2999-U. LICENSURE. 1. THE COMMISSIONER SHALL LICENSE AN ENTITY AS A
 PACE ORGANIZATION IF THE ENTITY:
   (A) COMPLIES WITH THE REQUIREMENTS OF A PACE ORGANIZATION UNDER APPLI-
 CABLE FEDERAL LAW AND REGULATIONS;
   (B) PROVIDES A FACILITY OR FACILITIES AT WHICH PRIMARY CARE AND  OTHER
 SERVICES ARE FURNISHED TO ENROLLEES;
   (C)  PROVIDES  AN  INTERDISCIPLINARY TEAM APPROACH TO CARE MANAGEMENT,
 CARE DELIVERY AND CARE PLANNING;
   (D) COMPLIES WITH THIS ARTICLE AND  REGULATIONS  OF  THE  COMMISSIONER
 UNDER THIS ARTICLE; AND
   (E) ENTERS INTO A PACE ORGANIZATION CONTRACT AND AGREEMENT WITH CMS.
   2.  (A)  A PACE ORGANIZATION SHALL COMPLY WITH APPLICABLE REQUIREMENTS
 OF ARTICLES FORTY-FOUR, THIRTY-SIX AND TWENTY-EIGHT OF THIS CHAPTER.
   (B) A PACE ORGANIZATION SHALL SERVE  AN  APPROVED  GEOGRAPHIC  SERVICE
 AREA.
   (C)  A  PACE  ORGANIZATION AND ITS INCORPORATORS, DIRECTORS, SPONSORS,
 STOCKHOLDERS AND OPERATORS SHALL HAVE THE  EXPERIENCE,  COMPETENCE,  AND
 STANDING IN THE COMMUNITY AS TO GIVE REASONABLE ASSURANCE OF THEIR ABIL-
 ITY  TO OPERATE THE ORGANIZATION TO PROVIDE A CONSISTENTLY HIGH LEVEL OF
 CARE FOR ENROLLEES AND COMPLY WITH THIS  ARTICLE.  A  PACE  ORGANIZATION
 SHALL DEMONSTRATE THAT WHERE ANY INCORPORATOR, DIRECTOR, SPONSOR, STOCK-
 HOLDER  OR  OPERATOR OF THE ORGANIZATION HOLDS, OR WITHIN THE PAST SEVEN
 YEARS HAS HELD, A CONTROLLING INTEREST OR BEEN A CONTROLLING  PERSON  IN
 AN  ORGANIZATION OR FACILITY LICENSED UNDER THIS CHAPTER, A CONSISTENTLY
 HIGH LEVEL OF CARE HAS BEEN RENDERED IN EACH SUCH ORGANIZATION OR FACIL-
 ITY.
   (D) A PACE ORGANIZATION SHALL MEET REQUIREMENTS FOR FINANCIAL SOLVENCY
 UNDER PARAGRAPH (C) OF SUBDIVISION ONE  OF  SECTION  FORTY-FOUR  HUNDRED
 THREE  OF THIS CHAPTER, INCLUDING A CONTINGENT RESERVE REQUIREMENT WHICH
 MAY, BY REGULATIONS OF THE COMMISSIONER, BE DIFFERENT FROM THAT REQUIRED
 BY THAT PARAGRAPH.
 A. 9542                             3
 
   (E) A PACE ORGANIZATION SHALL BE DEEMED TO  BE  A  HEALTH  MAINTENANCE
 ORGANIZATION  UNDER  ARTICLE  FORTY-FOUR OF THIS CHAPTER, BUT SOLELY FOR
 PURPOSES OF SUBDIVISION ONE OF SECTION SIXTY-FIVE  HUNDRED  TWENTY-SEVEN
 OF THE EDUCATION LAW.
   3.  THE  COMMISSIONER  SHALL ESTABLISH A UNIFIED LICENSURE PROCESS FOR
 PACE ORGANIZATIONS THAT INCLUDES THE APPLICABLE PROGRAM REQUIREMENTS  OF
 THIS ARTICLE. A LICENSE UNDER THIS ARTICLE SHALL REQUIRE APPROVAL OF THE
 PUBLIC HEALTH AND HEALTH PLANNING COUNCIL.
   § 2999-V. ELIGIBILITY AND ENROLLMENT. 1. TO BE ELIGIBLE TO ENROLL IN A
 PACE ORGANIZATION, AN INDIVIDUAL SHALL:
   (A) BE AT LEAST FIFTY-FIVE YEARS OLD; AND
   (B)  MEET  THE  ELIGIBILITY  REQUIREMENTS  FOR A NURSING HOME LEVEL OF
 CARE; AND
   (C) RESIDE WITHIN THE PACE ORGANIZATION'S APPROVED SERVICE AREA; AND
   (D) BE ABLE TO BE MAINTAINED SAFELY  IN  THE  COMMUNITY-BASED  SETTING
 WITH THE ASSISTANCE OF THE PACE ORGANIZATION; OR
   (E)  BE  OTHERWISE  ELIGIBLE TO PARTICIPATE IN A PACE DEMONSTRATION OR
 SPECIALTY PROGRAM AUTHORIZED BY THE  FEDERAL  PACE  INNOVATION  ACT  AND
 APPROVED BY CMS.
   2. ENROLLMENT IN A PACE ORGANIZATION SHALL BE VOLUNTARY FOR THE ELIGI-
 BLE INDIVIDUAL.
   § 2999-W. BENEFITS. 1. A PACE ORGANIZATION SHALL PROVIDE THE FOLLOWING
 BENEFITS TO ITS ENROLLEES:
   (A) ALL BENEFITS UNDER MEDICAID, INCLUDING UNDER SECTION THREE HUNDRED
 SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW;
   (B)  ALL  BENEFITS  UNDER MEDICARE, FOR ENROLLEES THAT ARE ENROLLED IN
 MEDICARE; AND
   (C) OTHER SERVICES DETERMINED NECESSARY  BY  THE  PACE  ORGANIZATION'S
 INTERDISCIPLINARY  TEAM  TO  IMPROVE AND MAINTAIN THE ENROLLEE'S OVERALL
 HEALTH STATUS.
   2. A PACE ORGANIZATION MAY PROVIDE FISCAL INTERMEDIARY SERVICES  UNDER
 SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL SERVICES LAW.
   §  2999-X. REIMBURSEMENT. 1. THE COMMISSIONER SHALL DEVELOP AND IMPLE-
 MENT, CONSISTENT WITH  APPLICABLE  FEDERAL  REQUIREMENTS,  REIMBURSEMENT
 RATES  AND METHODOLOGIES FOR MEDICAID SERVICES PROVIDED BY A PACE ORGAN-
 IZATION TO ITS ENROLLEES.
   2. THE COMMISSIONER SHALL PROVIDE, OR SHALL  REQUIRE  ANY  INDEPENDENT
 ACTUARY  USED  TO  REVIEW  PACE  REIMBURSEMENT RATES TO PROVIDE, TO PACE
 ORGANIZATIONS THE DOCUMENTS AND INFORMATION REGARDING PACE REIMBURSEMENT
 RATES SUBMITTED TO CMS IN A  FORM  AND  TIMEFRAME  CONSISTENT  WITH  THE
 REQUIREMENTS  FOR  PROVIDING  OR  CAUSING  TO  BE PROVIDED DOCUMENTS AND
 INFORMATION TO MEDICAID MANAGED CARE PROVIDERS UNDER  PARAGRAPH  (C)  OF
 SUBDIVISION EIGHTEEN OF SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL
 SERVICES LAW.
   §  2999-Y. REGULATIONS. 1. THE COMMISSIONER SHALL MAKE REGULATIONS AND
 TAKE OTHER ACTIONS REASONABLY NECESSARY TO IMPLEMENT THIS ARTICLE.
   2. THE COMMISSIONER SHALL DEVELOP AND IMPLEMENT A UNIFIED PROCESS  FOR
 PACE  ORGANIZATIONS  TO  COMPLETE  REPORTS, SUBMIT TO AUDITS, RESPOND TO
 SURVEYS, AND PROVIDE OTHER INFORMATION, INCLUDING MAXIMIZING  CONFORMITY
 WITH FEDERAL REQUIREMENTS.
   3.  THE  COMMISSIONER  MAY APPLY FOR FEDERAL WAIVERS UNDER MEDICAID OR
 DEMONSTRATION PROGRAMS UNDER MEDICARE  RELATING  TO  THE  PACE  PROGRAM,
 PROVIDED  THAT  THE WAIVER OR DEMONSTRATION SHALL NOT DIMINISH ANY RIGHT
 OR BENEFIT OF ENROLLEES UNDER THIS ARTICLE.
   § 3. Severability. If any provision of this act, or any application of
 any provision of this act, is held to be invalid, or to  violate  or  be
 A. 9542                             4
 
 inconsistent  with  any federal law or regulation, that shall not affect
 the validity or effectiveness of any other provision of this act  or  of
 any  other  application of any provision of this act, which can be given
 effect  without  that  provision  or  application;  and to that end, the
 provisions and applications of this act are severable.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law. Effective immediately, the  commissioner  of
 health  shall  make regulations and take other actions reasonably neces-
 sary to implement this act on that date.