FINAL BILL REPORT

SHB 1499

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background:

The Program for All-Inclusive Care for the Elderly (PACE) is one of several long-term care services programs offered by the Department of Social and Health Services to help elderly clients remain in the community. The PACE is a capitated benefit that may be offered under a state's Medicaid program. The PACE integrates necessary long-term care, medical services, mental health services, and alcohol and substance abuse treatment services. The PACE is available to people who:

are (a) age 65 or older or (b) age 55 or older and blind or disabled;
need nursing facility level of care;
live within a PACE provider's designated service area; and
are not enrolled in any other Medicare or Medicaid prepayment plan or optional benefit.

Individuals enrolled in the PACE must agree to receive services exclusively through the PACE provider and its network of providers. The available long-term care services under PACE include care coordination, home and community-based services, and nursing facility care. The medical care services available under the PACE include primary medical care, vision care, end of life care, restorative therapies, oxygen therapy, audiology, transportation, podiatry, durable medical equipment, dental care, pharmaceutical products, immunizations and vaccines, emergency care and inpatient hospital stays.

Individuals may voluntarily disenroll in the PACE at any time. Under state law, individuals may also be involuntarily disenrolled from the PACE under several circumstances, including if they no longer meet the nursing facility level of care requirement.

Summary:

The Department of Social and Health Services (DSHS) must allow long-term care clients who are enrolled in the Program for All-Inclusive Care for the Elderly (PACE) to remain in PACE, if the client so chooses, despite having improved status related to functional criteria for nursing facility level of care.

The DSHS must develop and implement a coordinated plan to educate specified people about the PACE site operations. The plan must include a strategy to assure that case managers and other staff who make eligibility determinations discuss with potentially eligible clients the option of enrolling in the PACE and the potential benefits of participating. The plan must also require that referrals for an evaluation are made to a PACE provider for all clients who (1) are eligible for the Community Options Program Entry System waiver program, (2) are 55 years old or over, and (3) live in a PACE service area. Lastly, the plan must require additional and ongoing training related to informing clients of the benefits of remaining in the PACE. The DSHS must identify a private entity that operates the PACE program sites in Washington to provide the training at no cost to the state.

Votes on Final Passage:

House	98	0
Senate	46	0