PHHPC Discusses PACE Expansion, Renews COVID-19 Emergency Regulations

On June 2, 2022, the Public Health and Health Planning Council (PHHPC) discussed Program of All-Inclusive Care for the Elderly (PACE program) governance options that would facilitate expansion of for-profit ownership of PACE programs. The Council also extended several COVID-19-related emergency regulations and initiated the permanent adoption process for two regulations – the regulation requiring nursing homes and adult care facilities (ACFs) to offer or arrange for COVID-19 vaccinations and the regulation requiring stockpiles of personal protective equipment (PPE) for hospitals and nursing homes. Meeting materials are available here, and the webcast is available here.

Friedman's presentation focused on the advantages of PACE programs and barriers to PACE expansion in New York State. He noted access to capital as a major challenge for PACE programs and identified for-profit, investor-owned entities as a potential source of capital. However, New York's regulatory requirements for the certification of managed care plans and for the ownership of diagnostic and treatment centers (D&TCs), together with federal PACE requirements, present barriers to the establishment of for-profit PACE programs. Friedman described the advantages and disadvantages of three possible options for PACE governance to facilitate ownership of PACE programs by for-profit, investor-owned entities:

1. Representative Governance
2. Contracted D&TC Service Model
3. Contracted Physician Practice Model

Friedman described the Contracted D&TC Service Model as the simplest approach and noted concerns that the Contracted Physician Practice Model would be subject to very limited oversight. He noted that legislation recently passed by both houses of the Legislature would create an integrated certification and licensure process for PACE programs that would streamline the process and mitigate barriers to for-profit entry.

Friedman also described other PACE reforms under way in New York, including:

• Allowing direct enrollment of potentially eligible PACE members without initial review by the Conflict-Free Evaluation and Enrollment Center;
• Exclusion of PACE from the Independent Assessor process for enrollees and prospective enrollees;
• Inclusion of non-emergency medical transportation in the PACE benefit package;
• Exemption of PACE programs from rate range reductions that apply to other MLTC plans;
• Working to increase the "amount otherwise paid" (AWOP) calculation, especially downstate, to ensure appropriate rates for PACE programs.

Some PHHPC members expressed discomfort with for-profit ownership of PACE programs and suggested that the State should, instead, support non-profit PACE operators to access capital. Others expressed the view that there are many creative ways to raise capital and that both investor-ownership and support for non-profit capital development should be pursued.

In addition to discussing PACE programs, the PHHPC renewed several emergency regulations for another 45 days:

• COVID-19 Vaccinations of Nursing Home and ACF Residents and Personnel
• Hospital and Nursing Home PPE Requirements
• Investigation of Communicable Disease; Isolation and Quarantine
• Face Coverings for COVID-19 Prevention
• Surge and Flex Health Coordination System

The following regulations were also presented "for information" in preparation for their publication with a 60-day comment period for permanent adoption:

• COVID-19 Vaccinations of Nursing Home and ACF Residents and Personnel
• Hospital and Nursing Home PPE Requirements

LeadingAge NY's letter to the PHHPC on the proposed regulations is here. LeadingAge NY will be tracking and submitting comments on regulations and policy initiatives affecting our members.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838