S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4137
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             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:
 
   Section 1. Section 1 of 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, is amended to read 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, PROVIDED HOWEVER THAT THIS  SHALL  NOT  PROHIBIT  THE
 APPLICATION OF REQUIREMENTS UNDER SUCH ARTICLE OR OTHER APPLICABLE LAWS,
 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
              

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 OF HEALTH OR SUPERINTENDENT OF INSURANCE PURSUANT TO REGULATIONS PROMUL-
 GATED BY THE COMMISSIONER UNDER THIS ACT.
   §  2. Sections 2999-u, 2999-v, 2999-w, 2999-x and 2999-y of the public
 health law, as added by 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, are amended to read as follows:
   §  2999-u.  Licensure.  1.  The  commissioner  shall license an entity
 APPLYING FOR LICENSURE as a PACE organization if the [entity]  APPLICANT
 DEMONSTRATES  TO THE SATISFACTION OF THE COMMISSIONER THAT THE APPLICANT
 WILL:
   (a) [complies] COMPLY with the requirements  of  a  PACE  organization
 under applicable federal law and regulations;
   (b)  [provides] PROVIDE a facility or facilities at which primary care
 and other services are furnished to enrollees;
   (c) [provides] PROVIDE an  interdisciplinary  team  approach  to  care
 management, care delivery and care planning;
   (d)  [complies] COMPLY with this article, THE APPLICABLE PROVISIONS OF
 ARTICLES TWENTY-EIGHT, THIRTY-SIX AND FORTY-FOUR  OF  THIS  CHAPTER  AND
 REGULATIONS  THEREUNDER,  and regulations of the commissioner under this
 article; and
   (e) [enters] ENTER into a PACE  organization  contract  and  agreement
 with THE DEPARTMENT AND 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)]  (B) A PACE organization and its incorporators, directors, spon-
 sors, stockholders, MEMBERS, and operators shall  have  the  experience,
 competence,  and  standing in the community as to give reasonable assur-
 ance of their ability to operate the organization to provide a  consist-
 ently  high  level of care for enrollees and comply with this article. A
 PACE organization shall demonstrate that where any incorporator,  direc-
 tor,  sponsor,  stockholder,  MEMBER,  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 facility.
   [(d)]  (C)  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 require-
 ment which may, by regulations of the commissioner,  be  different  from
 that required by that paragraph.
   [(e)]  (D)  A PACE organization shall be deemed to be a health mainte-
 nance organization under article forty-four of this chapter[, but  sole-
 ly]  for purposes of subdivision one of section sixty-five hundred twen-
 ty-seven of the education law.
   3. (A) The commissioner shall establish IN REGULATION a unified licen-
 sure process for PACE organizations that includes the applicable program
 requirements of this article AND ARTICLES TWENTY-EIGHT,  THIRTY-SIX  AND
 FORTY-FOUR OF THIS CHAPTER.
   (B)  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) (I) be at least fifty-five years old; [and
 A. 4137                             3

   (b)] (II) meet the eligibility requirements for a nursing  home  level
 of care; [and
   (c)]  (III)  reside  within  the  PACE organization's approved service
 area; [and
   (d)] (IV) be able to  be  maintained  safely  in  the  community-based
 setting with the assistance of the PACE organization; [or (e)] AND
   (V)  MEET  ANY  ADDITIONAL  PROGRAM  SPECIFIC  ELIGIBILITY  CONDITIONS
 IMPOSED UNDER THE PACE PROGRAM AGREEMENT BETWEEN THE PACE  ORGANIZATION,
 THE DEPARTMENT, AND CMS; OR
   (B)  be  otherwise  eligible to participate in a PACE demonstration or
 specialty program authorized by the  federal  PACE  Innovation  Act  and
 approved by THE DEPARTMENT AND 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  IF
 APPROVED 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  reimburse-
 ment 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 AND APPLICABLE LAWS. 1.  The commissioner shall
 make regulations and take other actions reasonably necessary  to  imple-
 ment  this  article,  INCLUDING THE ESTABLISHMENT OF ANY RULES AND PROC-
 ESSES APPROPRIATE FOR THE SAFE, EFFICIENT AND ORDERLY ADMINISTRATION  OF
 THE  PROGRAM  AND  FOR THE MAINTENANCE AND REVOCATION OF LICENSURE UNDER
 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] (A) LICENSURE GRANTED UNDER THIS ARTICLE MAY,
 IN ACCORDANCE WITH THE APPROVAL BY THE COMMISSIONER,  ENTITLE  THE  PACE
 ORGANIZATION  TO  ACT  IN  THE  CAPACITY AND PERFORM THE ACTIVITIES OF A
 DIAGNOSTIC AND TREATMENT CENTER, HOME CARE SERVICES AGENCY, HEALTH MAIN-
 TENANCE ORGANIZATION, OR MANAGED LONG TERM CARE PLAN FOR WHICH LICENSURE
 OR CERTIFICATION IS OTHERWISE REQUIRED UNDER ARTICLE TWENTY-EIGHT, THIR-
 TY-SIX, OR FORTY-FOUR OF THIS CHAPTER AS APPLICABLE WITHOUT  SUCH  SEPA-
 RATE LICENSE OR CERTIFICATION FOR PURPOSES RELATING TO THE PACE.
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   (B)  TO  THE EXTENT THAT A PACE ORGANIZATION IS ACTING IN THE CAPACITY
 OR PERFORMING AN ACTIVITY FOR WHICH LICENSURE OR CERTIFICATION IS OTHER-
 WISE REQUIRED UNDER ARTICLE TWENTY-EIGHT, THIRTY-SIX, OR  FORTY-FOUR  OF
 THIS  CHAPTER,  THE  PACE  ORGANIZATION SHALL COMPLY WITH THE APPLICABLE
 REQUIREMENTS  OF  SUCH  ARTICLES  AND ANY APPLICABLE REGULATIONS ADOPTED
 THEREUNDER; EXCEPT THAT WHERE SUCH REQUIREMENTS  ARE  INCONSISTENT  WITH
 THE  REQUIREMENTS  OF THIS ARTICLE OR REGULATIONS ADOPTED BY THE COMMIS-
 SIONER UNDER THIS ARTICLE, THE REQUIREMENTS OF  THIS  ARTICLE  AND  SUCH
 REGULATIONS SHALL APPLY.
   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. This act shall take effect on the  same  date  and  in  the  same
 manner  as  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, takes effect.