S T A T E O F N E W Y O R K
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8903
I N S E N A T E
April 27, 2022
___________
Introduced by Sen. MAY -- read twice and ordered printed, and when
printed to be committed 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
S. 8903 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.
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(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
S. 8903 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.
