California 2019 2019-2020 Regular Session

California Assembly Bill AB1128 Amended / Bill

Filed 06/24/2019

                    Amended IN  Senate  June 24, 2019 Amended IN  Assembly  May 16, 2019 Amended IN  Assembly  March 26, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1128Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Kalra, Voepel, and Patterson)(Coauthors: Assembly Members Boerner Horvath, Kalra, Patterson, Blanca Rubio, and Voepel)(Coauthor: Senator Rubio)February 21, 2019 An act to add Sections 1221.18, 1575.5, and 1734.6 to the Health and Safety Code, and to amend Section 14592 of the Welfare and Institutions Code, relating to the elderly. LEGISLATIVE COUNSEL'S DIGESTAB 1128, as amended, Petrie-Norris. 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 states 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 centers, and home health agencies.This bill would require a PACE center to maintain a license as both a primary care clinic and an adult day health center, and to either maintain a license as a home health agency or contract with a licensed home health agency for the provision of home health services. The bill would require the State Department of Health Care Services, as the single state agency overseeing the PACE program, to license and regulate any primary care clinic, adult day health center, and home health agency that is related to a PACE center, thereby transferring these duties from the State Department of Public Health to the State Department of Health Care Services, using revenues from the licensing fees that would have been attributed to the corresponding duties of the State Department of Public Health. The bill would authorize the State Department of Health Care Services to exempt certain PACE centers from these provisions. The bill would authorize the State Department of Health Care Services to implement the transfer of these duties by means of plan or county letters, or other similar instructions, without taking regulatory action.Digest Key Vote: MAJORITY  Appropriation: NO  Fiscal Committee: YES  Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) The Program of All-Inclusive Care for the Elderly (PACE) is a national model of comprehensive care for Californias frail population 55 years of age and older who qualify for nursing home placement but wish to remain in the community.(b) Research shows that PACE produces significant improvements for the beneficiaries it serves, including fewer hospitalizations, fewer nursing home admissions, higher quality of life, and greater rates of satisfaction with overall care.(c) The PACE model achieves savings for the State of California. In 2017, the state paid $22,600,000 less than it would have if all current PACE participants were served outside of PACE.(d) Currently, there are 12 PACE programs operating in 42 sites across California, serving almost over 8,000 seniors.(e) PACE organizations are currently required to obtain licensing approvals or exemptions to operate clinics, adult day health centers, and, in some cases, home health agencies, from the State Department of Public Health (DPH) in a lengthy process that is separate from the extensive approval process administered by the State Department of Health Care Services (DHCS).(f) This bifurcated process can delay the rollout of new and expanding PACE programs by months or even years.(g) Startup of new PACE programs and certain expansions of existing programs are further challenged by DHCS policy limiting the start date of operations for a new or expanding PACE organization application only to either January 1 or July 1 of a given year following approval.(g)(h) Therefore, it is the intent of the Legislature to shift responsibility for PACE licensing from DPH to DHCS to remove redundancy and duplication between the reviews by the two departments, and expedite approval of new or expanding PACE programs that will help more seniors access PACE while remaining in their homes and communities.SEC. 2. Section 1221.18 is added to the Health and Safety Code, to read:1221.18. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any primary care clinic license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.SEC. 3. Section 1575.5 is added to the Health and Safety Code, to read:1575.5. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any adult day health center license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.SEC. 4. Section 1734.6 is added to the Health and Safety Code, to read:1734.6. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any home health agency license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.SEC. 5. Section 14592 of the Welfare and Institutions Code is amended to read:14592. (a) For purposes of this chapter, PACE organization means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(b) The director shall establish 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 states Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation.(c) A PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, shall maintain a license as both a primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, and an adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code. Additionally, a PACE center shall elect to either maintain a license as a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, or contract with a licensed home health agency for the provision of home health services.(d) (1) Notwithstanding any other law, including Division 2 (commencing with Section 1200) of the Health and Safety Code, the department, as the single state agency overseeing the PACE program, shall assume the duties of the State Department of Public Health relating to the licensing and regulation of any primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, and home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(2) The transfer of these duties shall occur by a date collectively determined by the department and the State Department of Public Health, but no later than January 1, 2021.(3) (A) Notwithstanding any other law, moneys authorized to fund the duties of the State Department of Public Health relating to the licensing and regulation of an entity described in paragraph (1) that is related to a PACE center, including moneys collected in accordance with Section 1266 of the Health and Safety Code and deposited in the State Department of Public Health Licensing and Certification Program Fund pursuant to Section 1266.9 of the Health and Safety Code, shall be authorized to fund those same duties upon their transfer to the department pursuant to this subdivision.(B) It is the intent of the Legislature that the duties of the department as described in paragraph (1) not be funded by an appropriation from the General Fund.(e) Consistent with Sections 1231.5, 1580.1, and 1734.5 of the Health and Safety Code, and in accordance with Section 100315 of the Health and Safety Code, the department may exempt a PACE center from subdivisions (c) and (d).(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement subdivisions (c) through (e) by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking regulatory action.

 Amended IN  Senate  June 24, 2019 Amended IN  Assembly  May 16, 2019 Amended IN  Assembly  March 26, 2019 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION Assembly Bill No. 1128Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Kalra, Voepel, and Patterson)(Coauthors: Assembly Members Boerner Horvath, Kalra, Patterson, Blanca Rubio, and Voepel)(Coauthor: Senator Rubio)February 21, 2019 An act to add Sections 1221.18, 1575.5, and 1734.6 to the Health and Safety Code, and to amend Section 14592 of the Welfare and Institutions Code, relating to the elderly. LEGISLATIVE COUNSEL'S DIGESTAB 1128, as amended, Petrie-Norris. 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 states 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 centers, and home health agencies.This bill would require a PACE center to maintain a license as both a primary care clinic and an adult day health center, and to either maintain a license as a home health agency or contract with a licensed home health agency for the provision of home health services. The bill would require the State Department of Health Care Services, as the single state agency overseeing the PACE program, to license and regulate any primary care clinic, adult day health center, and home health agency that is related to a PACE center, thereby transferring these duties from the State Department of Public Health to the State Department of Health Care Services, using revenues from the licensing fees that would have been attributed to the corresponding duties of the State Department of Public Health. The bill would authorize the State Department of Health Care Services to exempt certain PACE centers from these provisions. The bill would authorize the State Department of Health Care Services to implement the transfer of these duties by means of plan or county letters, or other similar instructions, without taking regulatory action.Digest Key Vote: MAJORITY  Appropriation: NO  Fiscal Committee: YES  Local Program: NO 

 Amended IN  Senate  June 24, 2019 Amended IN  Assembly  May 16, 2019 Amended IN  Assembly  March 26, 2019

Amended IN  Senate  June 24, 2019
Amended IN  Assembly  May 16, 2019
Amended IN  Assembly  March 26, 2019

 CALIFORNIA LEGISLATURE 20192020 REGULAR SESSION

Assembly Bill No. 1128

Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Kalra, Voepel, and Patterson)(Coauthors: Assembly Members Boerner Horvath, Kalra, Patterson, Blanca Rubio, and Voepel)(Coauthor: Senator Rubio)February 21, 2019

Introduced by Assembly Member Petrie-Norris(Coauthors: Assembly Members Kalra, Voepel, and Patterson)(Coauthors: Assembly Members Boerner Horvath, Kalra, Patterson, Blanca Rubio, and Voepel)(Coauthor: Senator Rubio)
February 21, 2019

 An act to add Sections 1221.18, 1575.5, and 1734.6 to the Health and Safety Code, and to amend Section 14592 of the Welfare and Institutions Code, relating to the elderly. 

LEGISLATIVE COUNSEL'S DIGEST

## LEGISLATIVE COUNSEL'S DIGEST

AB 1128, as amended, Petrie-Norris. 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 states 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 centers, and home health agencies.This bill would require a PACE center to maintain a license as both a primary care clinic and an adult day health center, and to either maintain a license as a home health agency or contract with a licensed home health agency for the provision of home health services. The bill would require the State Department of Health Care Services, as the single state agency overseeing the PACE program, to license and regulate any primary care clinic, adult day health center, and home health agency that is related to a PACE center, thereby transferring these duties from the State Department of Public Health to the State Department of Health Care Services, using revenues from the licensing fees that would have been attributed to the corresponding duties of the State Department of Public Health. The bill would authorize the State Department of Health Care Services to exempt certain PACE centers from these provisions. The bill would authorize the State Department of Health Care Services to implement the transfer of these duties by means of plan or county letters, or other similar instructions, without taking regulatory action.

 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 states 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 centers, and home health agencies.

This bill would require a PACE center to maintain a license as both a primary care clinic and an adult day health center, and to either maintain a license as a home health agency or contract with a licensed home health agency for the provision of home health services. The bill would require the State Department of Health Care Services, as the single state agency overseeing the PACE program, to license and regulate any primary care clinic, adult day health center, and home health agency that is related to a PACE center, thereby transferring these duties from the State Department of Public Health to the State Department of Health Care Services, using revenues from the licensing fees that would have been attributed to the corresponding duties of the State Department of Public Health. The bill would authorize the State Department of Health Care Services to exempt certain PACE centers from these provisions. The bill would authorize the State Department of Health Care Services to implement the transfer of these duties by means of plan or county letters, or other similar instructions, without taking regulatory action.

## Digest Key

## Bill Text

The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares all of the following:(a) The Program of All-Inclusive Care for the Elderly (PACE) is a national model of comprehensive care for Californias frail population 55 years of age and older who qualify for nursing home placement but wish to remain in the community.(b) Research shows that PACE produces significant improvements for the beneficiaries it serves, including fewer hospitalizations, fewer nursing home admissions, higher quality of life, and greater rates of satisfaction with overall care.(c) The PACE model achieves savings for the State of California. In 2017, the state paid $22,600,000 less than it would have if all current PACE participants were served outside of PACE.(d) Currently, there are 12 PACE programs operating in 42 sites across California, serving almost over 8,000 seniors.(e) PACE organizations are currently required to obtain licensing approvals or exemptions to operate clinics, adult day health centers, and, in some cases, home health agencies, from the State Department of Public Health (DPH) in a lengthy process that is separate from the extensive approval process administered by the State Department of Health Care Services (DHCS).(f) This bifurcated process can delay the rollout of new and expanding PACE programs by months or even years.(g) Startup of new PACE programs and certain expansions of existing programs are further challenged by DHCS policy limiting the start date of operations for a new or expanding PACE organization application only to either January 1 or July 1 of a given year following approval.(g)(h) Therefore, it is the intent of the Legislature to shift responsibility for PACE licensing from DPH to DHCS to remove redundancy and duplication between the reviews by the two departments, and expedite approval of new or expanding PACE programs that will help more seniors access PACE while remaining in their homes and communities.SEC. 2. Section 1221.18 is added to the Health and Safety Code, to read:1221.18. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any primary care clinic license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.SEC. 3. Section 1575.5 is added to the Health and Safety Code, to read:1575.5. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any adult day health center license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.SEC. 4. Section 1734.6 is added to the Health and Safety Code, to read:1734.6. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any home health agency license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.SEC. 5. Section 14592 of the Welfare and Institutions Code is amended to read:14592. (a) For purposes of this chapter, PACE organization means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(b) The director shall establish 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 states Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation.(c) A PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, shall maintain a license as both a primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, and an adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code. Additionally, a PACE center shall elect to either maintain a license as a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, or contract with a licensed home health agency for the provision of home health services.(d) (1) Notwithstanding any other law, including Division 2 (commencing with Section 1200) of the Health and Safety Code, the department, as the single state agency overseeing the PACE program, shall assume the duties of the State Department of Public Health relating to the licensing and regulation of any primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, and home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(2) The transfer of these duties shall occur by a date collectively determined by the department and the State Department of Public Health, but no later than January 1, 2021.(3) (A) Notwithstanding any other law, moneys authorized to fund the duties of the State Department of Public Health relating to the licensing and regulation of an entity described in paragraph (1) that is related to a PACE center, including moneys collected in accordance with Section 1266 of the Health and Safety Code and deposited in the State Department of Public Health Licensing and Certification Program Fund pursuant to Section 1266.9 of the Health and Safety Code, shall be authorized to fund those same duties upon their transfer to the department pursuant to this subdivision.(B) It is the intent of the Legislature that the duties of the department as described in paragraph (1) not be funded by an appropriation from the General Fund.(e) Consistent with Sections 1231.5, 1580.1, and 1734.5 of the Health and Safety Code, and in accordance with Section 100315 of the Health and Safety Code, the department may exempt a PACE center from subdivisions (c) and (d).(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement subdivisions (c) through (e) by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking regulatory action.

The people of the State of California do enact as follows:

## The people of the State of California do enact as follows:

SECTION 1. The Legislature finds and declares all of the following:(a) The Program of All-Inclusive Care for the Elderly (PACE) is a national model of comprehensive care for Californias frail population 55 years of age and older who qualify for nursing home placement but wish to remain in the community.(b) Research shows that PACE produces significant improvements for the beneficiaries it serves, including fewer hospitalizations, fewer nursing home admissions, higher quality of life, and greater rates of satisfaction with overall care.(c) The PACE model achieves savings for the State of California. In 2017, the state paid $22,600,000 less than it would have if all current PACE participants were served outside of PACE.(d) Currently, there are 12 PACE programs operating in 42 sites across California, serving almost over 8,000 seniors.(e) PACE organizations are currently required to obtain licensing approvals or exemptions to operate clinics, adult day health centers, and, in some cases, home health agencies, from the State Department of Public Health (DPH) in a lengthy process that is separate from the extensive approval process administered by the State Department of Health Care Services (DHCS).(f) This bifurcated process can delay the rollout of new and expanding PACE programs by months or even years.(g) Startup of new PACE programs and certain expansions of existing programs are further challenged by DHCS policy limiting the start date of operations for a new or expanding PACE organization application only to either January 1 or July 1 of a given year following approval.(g)(h) Therefore, it is the intent of the Legislature to shift responsibility for PACE licensing from DPH to DHCS to remove redundancy and duplication between the reviews by the two departments, and expedite approval of new or expanding PACE programs that will help more seniors access PACE while remaining in their homes and communities.

SECTION 1. The Legislature finds and declares all of the following:(a) The Program of All-Inclusive Care for the Elderly (PACE) is a national model of comprehensive care for Californias frail population 55 years of age and older who qualify for nursing home placement but wish to remain in the community.(b) Research shows that PACE produces significant improvements for the beneficiaries it serves, including fewer hospitalizations, fewer nursing home admissions, higher quality of life, and greater rates of satisfaction with overall care.(c) The PACE model achieves savings for the State of California. In 2017, the state paid $22,600,000 less than it would have if all current PACE participants were served outside of PACE.(d) Currently, there are 12 PACE programs operating in 42 sites across California, serving almost over 8,000 seniors.(e) PACE organizations are currently required to obtain licensing approvals or exemptions to operate clinics, adult day health centers, and, in some cases, home health agencies, from the State Department of Public Health (DPH) in a lengthy process that is separate from the extensive approval process administered by the State Department of Health Care Services (DHCS).(f) This bifurcated process can delay the rollout of new and expanding PACE programs by months or even years.(g) Startup of new PACE programs and certain expansions of existing programs are further challenged by DHCS policy limiting the start date of operations for a new or expanding PACE organization application only to either January 1 or July 1 of a given year following approval.(g)(h) Therefore, it is the intent of the Legislature to shift responsibility for PACE licensing from DPH to DHCS to remove redundancy and duplication between the reviews by the two departments, and expedite approval of new or expanding PACE programs that will help more seniors access PACE while remaining in their homes and communities.

SECTION 1. The Legislature finds and declares all of the following:

### SECTION 1.

(a) The Program of All-Inclusive Care for the Elderly (PACE) is a national model of comprehensive care for Californias frail population 55 years of age and older who qualify for nursing home placement but wish to remain in the community.

(b) Research shows that PACE produces significant improvements for the beneficiaries it serves, including fewer hospitalizations, fewer nursing home admissions, higher quality of life, and greater rates of satisfaction with overall care.

(c) The PACE model achieves savings for the State of California. In 2017, the state paid $22,600,000 less than it would have if all current PACE participants were served outside of PACE.

(d) Currently, there are 12 PACE programs operating in 42 sites across California, serving almost over 8,000 seniors.

(e) PACE organizations are currently required to obtain licensing approvals or exemptions to operate clinics, adult day health centers, and, in some cases, home health agencies, from the State Department of Public Health (DPH) in a lengthy process that is separate from the extensive approval process administered by the State Department of Health Care Services (DHCS).

(f) This bifurcated process can delay the rollout of new and expanding PACE programs by months or even years.

(g) Startup of new PACE programs and certain expansions of existing programs are further challenged by DHCS policy limiting the start date of operations for a new or expanding PACE organization application only to either January 1 or July 1 of a given year following approval.

(g)



(h) Therefore, it is the intent of the Legislature to shift responsibility for PACE licensing from DPH to DHCS to remove redundancy and duplication between the reviews by the two departments, and expedite approval of new or expanding PACE programs that will help more seniors access PACE while remaining in their homes and communities.

SEC. 2. Section 1221.18 is added to the Health and Safety Code, to read:1221.18. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any primary care clinic license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

SEC. 2. Section 1221.18 is added to the Health and Safety Code, to read:

### SEC. 2.

1221.18. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any primary care clinic license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

1221.18. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any primary care clinic license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

1221.18. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any primary care clinic license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.



1221.18. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any primary care clinic license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

SEC. 3. Section 1575.5 is added to the Health and Safety Code, to read:1575.5. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any adult day health center license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

SEC. 3. Section 1575.5 is added to the Health and Safety Code, to read:

### SEC. 3.

1575.5. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any adult day health center license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

1575.5. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any adult day health center license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

1575.5. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any adult day health center license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.



1575.5. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any adult day health center license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

SEC. 4. Section 1734.6 is added to the Health and Safety Code, to read:1734.6. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any home health agency license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

SEC. 4. Section 1734.6 is added to the Health and Safety Code, to read:

### SEC. 4.

1734.6. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any home health agency license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

1734.6. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any home health agency license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

1734.6. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any home health agency license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.



1734.6. Pursuant to subdivision (d) of Section 14592 of the Welfare and Institutions Code, no later than January 1, 2021, the State Department of Health Care Services, as the single state agency overseeing the Program of All-Inclusive Care for the Elderly (PACE), as described in Chapter 8.75 (commencing with Section 14591) of Part 3 of Division 9 of the Welfare and Institutions Code, shall license and regulate any home health agency license that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

SEC. 5. Section 14592 of the Welfare and Institutions Code is amended to read:14592. (a) For purposes of this chapter, PACE organization means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(b) The director shall establish 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 states Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation.(c) A PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, shall maintain a license as both a primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, and an adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code. Additionally, a PACE center shall elect to either maintain a license as a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, or contract with a licensed home health agency for the provision of home health services.(d) (1) Notwithstanding any other law, including Division 2 (commencing with Section 1200) of the Health and Safety Code, the department, as the single state agency overseeing the PACE program, shall assume the duties of the State Department of Public Health relating to the licensing and regulation of any primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, and home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(2) The transfer of these duties shall occur by a date collectively determined by the department and the State Department of Public Health, but no later than January 1, 2021.(3) (A) Notwithstanding any other law, moneys authorized to fund the duties of the State Department of Public Health relating to the licensing and regulation of an entity described in paragraph (1) that is related to a PACE center, including moneys collected in accordance with Section 1266 of the Health and Safety Code and deposited in the State Department of Public Health Licensing and Certification Program Fund pursuant to Section 1266.9 of the Health and Safety Code, shall be authorized to fund those same duties upon their transfer to the department pursuant to this subdivision.(B) It is the intent of the Legislature that the duties of the department as described in paragraph (1) not be funded by an appropriation from the General Fund.(e) Consistent with Sections 1231.5, 1580.1, and 1734.5 of the Health and Safety Code, and in accordance with Section 100315 of the Health and Safety Code, the department may exempt a PACE center from subdivisions (c) and (d).(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement subdivisions (c) through (e) by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking regulatory action.

SEC. 5. Section 14592 of the Welfare and Institutions Code is amended to read:

### SEC. 5.

14592. (a) For purposes of this chapter, PACE organization means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(b) The director shall establish 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 states Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation.(c) A PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, shall maintain a license as both a primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, and an adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code. Additionally, a PACE center shall elect to either maintain a license as a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, or contract with a licensed home health agency for the provision of home health services.(d) (1) Notwithstanding any other law, including Division 2 (commencing with Section 1200) of the Health and Safety Code, the department, as the single state agency overseeing the PACE program, shall assume the duties of the State Department of Public Health relating to the licensing and regulation of any primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, and home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(2) The transfer of these duties shall occur by a date collectively determined by the department and the State Department of Public Health, but no later than January 1, 2021.(3) (A) Notwithstanding any other law, moneys authorized to fund the duties of the State Department of Public Health relating to the licensing and regulation of an entity described in paragraph (1) that is related to a PACE center, including moneys collected in accordance with Section 1266 of the Health and Safety Code and deposited in the State Department of Public Health Licensing and Certification Program Fund pursuant to Section 1266.9 of the Health and Safety Code, shall be authorized to fund those same duties upon their transfer to the department pursuant to this subdivision.(B) It is the intent of the Legislature that the duties of the department as described in paragraph (1) not be funded by an appropriation from the General Fund.(e) Consistent with Sections 1231.5, 1580.1, and 1734.5 of the Health and Safety Code, and in accordance with Section 100315 of the Health and Safety Code, the department may exempt a PACE center from subdivisions (c) and (d).(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement subdivisions (c) through (e) by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking regulatory action.

14592. (a) For purposes of this chapter, PACE organization means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(b) The director shall establish 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 states Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation.(c) A PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, shall maintain a license as both a primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, and an adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code. Additionally, a PACE center shall elect to either maintain a license as a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, or contract with a licensed home health agency for the provision of home health services.(d) (1) Notwithstanding any other law, including Division 2 (commencing with Section 1200) of the Health and Safety Code, the department, as the single state agency overseeing the PACE program, shall assume the duties of the State Department of Public Health relating to the licensing and regulation of any primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, and home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(2) The transfer of these duties shall occur by a date collectively determined by the department and the State Department of Public Health, but no later than January 1, 2021.(3) (A) Notwithstanding any other law, moneys authorized to fund the duties of the State Department of Public Health relating to the licensing and regulation of an entity described in paragraph (1) that is related to a PACE center, including moneys collected in accordance with Section 1266 of the Health and Safety Code and deposited in the State Department of Public Health Licensing and Certification Program Fund pursuant to Section 1266.9 of the Health and Safety Code, shall be authorized to fund those same duties upon their transfer to the department pursuant to this subdivision.(B) It is the intent of the Legislature that the duties of the department as described in paragraph (1) not be funded by an appropriation from the General Fund.(e) Consistent with Sections 1231.5, 1580.1, and 1734.5 of the Health and Safety Code, and in accordance with Section 100315 of the Health and Safety Code, the department may exempt a PACE center from subdivisions (c) and (d).(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement subdivisions (c) through (e) by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking regulatory action.

14592. (a) For purposes of this chapter, PACE organization means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(b) The director shall establish 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 states Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation.(c) A PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, shall maintain a license as both a primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, and an adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code. Additionally, a PACE center shall elect to either maintain a license as a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, or contract with a licensed home health agency for the provision of home health services.(d) (1) Notwithstanding any other law, including Division 2 (commencing with Section 1200) of the Health and Safety Code, the department, as the single state agency overseeing the PACE program, shall assume the duties of the State Department of Public Health relating to the licensing and regulation of any primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, and home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.(2) The transfer of these duties shall occur by a date collectively determined by the department and the State Department of Public Health, but no later than January 1, 2021.(3) (A) Notwithstanding any other law, moneys authorized to fund the duties of the State Department of Public Health relating to the licensing and regulation of an entity described in paragraph (1) that is related to a PACE center, including moneys collected in accordance with Section 1266 of the Health and Safety Code and deposited in the State Department of Public Health Licensing and Certification Program Fund pursuant to Section 1266.9 of the Health and Safety Code, shall be authorized to fund those same duties upon their transfer to the department pursuant to this subdivision.(B) It is the intent of the Legislature that the duties of the department as described in paragraph (1) not be funded by an appropriation from the General Fund.(e) Consistent with Sections 1231.5, 1580.1, and 1734.5 of the Health and Safety Code, and in accordance with Section 100315 of the Health and Safety Code, the department may exempt a PACE center from subdivisions (c) and (d).(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement subdivisions (c) through (e) by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking regulatory action.



14592. (a) For purposes of this chapter, PACE organization means an entity as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

(b) The director shall establish 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 states Medi-Cal State Plan and under contracts entered into between the federal Centers for Medicare and Medicaid Services, the department, and PACE organizations, meeting the requirements of the Balanced Budget Act of 1997 (Public Law 105-33) and any other applicable law or regulation.

(c) A PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations, shall maintain a license as both a primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, and an adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code. Additionally, a PACE center shall elect to either maintain a license as a home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, or contract with a licensed home health agency for the provision of home health services.

(d) (1) Notwithstanding any other law, including Division 2 (commencing with Section 1200) of the Health and Safety Code, the department, as the single state agency overseeing the PACE program, shall assume the duties of the State Department of Public Health relating to the licensing and regulation of any primary care clinic, as defined in paragraph (1) of subdivision (b) of Section 1200 of the Health and Safety Code, adult day health center, as defined in subdivision (b) of Section 1570.7 of the Health and Safety Code, and home health agency, as defined in subdivision (a) of Section 1727 of the Health and Safety Code, that is related to a PACE center, as defined in Section 460.6 of Title 42 of the Code of Federal Regulations.

(2) The transfer of these duties shall occur by a date collectively determined by the department and the State Department of Public Health, but no later than January 1, 2021.

(3) (A) Notwithstanding any other law, moneys authorized to fund the duties of the State Department of Public Health relating to the licensing and regulation of an entity described in paragraph (1) that is related to a PACE center, including moneys collected in accordance with Section 1266 of the Health and Safety Code and deposited in the State Department of Public Health Licensing and Certification Program Fund pursuant to Section 1266.9 of the Health and Safety Code, shall be authorized to fund those same duties upon their transfer to the department pursuant to this subdivision.

(B) It is the intent of the Legislature that the duties of the department as described in paragraph (1) not be funded by an appropriation from the General Fund.

(e) Consistent with Sections 1231.5, 1580.1, and 1734.5 of the Health and Safety Code, and in accordance with Section 100315 of the Health and Safety Code, the department may exempt a PACE center from subdivisions (c) and (d).

(f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement subdivisions (c) through (e) by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking regulatory action.