AB 1223

Bill Subjects

Medi-Cal Audit Of Pace Organizations

Abstract

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 so that they may continue living in the community. Federal law authorizes states to implement PACE 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. Existing law authorizes the State Department of Health Care Services to enter into contracts with public or private organizations for implementation of the PACE program and sets out mandatory requirements of the PACE model, as provided under federal law. This bill would require the department to perform program audits of PACE organizations and to develop and maintain standards, rules, and auditing protocols. The bill would require the protocol to include data collection procedures and formal decision rules and procedures for enforcement consequences when the requirements of law are not met.