summary
Introduced
02/04/2025
02/04/2025
In Committee
03/21/2025
03/21/2025
Crossed Over
Passed
Dead
Introduced Session
104th General Assembly
Bill Summary
Amends the Program of All-Inclusive Care for the Elderly Act. Provides that to ensure that organizations contracted to implement the Program of All-Inclusive Care for the Elderly (PACE) program meet the needs of PACE participants, the Department of Healthcare and Family Services shall reform the rate-setting methodology for the PACE program by establishing a blended rate structure based on a 30% Home and Community-Based Services and 70% Skilled Nursing Facility case-mix which is a more accurate proportion of the comparable population expected to reside in an institution or the community if not enrolled in PACE. Requires the blended rate structure to more accurately reflect the comprehensive nature of care provided by PACE organizations and address the unique needs of PACE participants as a higher risk/acuity population with expected higher costs and frailty than comparable populations. Provides that when developing rates under the blended rate structure, the Department must consider not only the standard cost experiences of PACE participants but also the unique characteristics and specific care needs of the PACE population as well as any additional State plan services or populations that are not included in the State's Medicaid managed care contracts but are required under the PACE program.
AI Summary
This bill amends the Program of All-Inclusive Care for the Elderly (PACE) Act to reform how rates are set for PACE organizations. Specifically, the bill requires the Department of Healthcare and Family Services to establish a new blended rate structure that more accurately reflects the comprehensive care provided to elderly participants. The new rate structure will be based on a 30% Home and Community-Based Services and 70% Skilled Nursing Facility case-mix, which better represents the expected population distribution. When developing these rates, the Department must consider the unique characteristics and care needs of PACE participants, recognizing that this population is higher risk with greater frailty and potentially higher costs compared to other populations. The bill removes previous language about rate development and replaces it with this more nuanced approach, ensuring that the funding methodology takes into account the specific services and populations served by PACE that may not be covered in standard Medicaid managed care contracts. The goal is to create a more appropriate and comprehensive funding mechanism that supports the specialized care provided to elderly participants through the PACE program.
Committee Categories
Budget and Finance
Sponsors (2)
Last Action
Added Co-Sponsor Rep. Camille Y. Lilly (on 04/10/2025)
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.ilga.gov/legislation/BillStatus.asp?DocNum=2665&GAID=18&DocTypeID=HB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/HB/10400HB2665.htm |
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