summary
Introduced
02/06/2025
02/06/2025
In Committee
06/02/2025
06/02/2025
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 by reforming the rate-setting methodology for PACE organizations. Specifically, the bill requires the Department of Healthcare and Family Services to establish a new blended rate structure that is based on 30% Home and Community-Based Services and 70% Skilled Nursing Facility case-mix, which better reflects the expected population distribution. The new rate structure aims to more accurately capture the comprehensive care provided by PACE organizations and account for the unique characteristics of PACE participants, who are typically a higher-risk, higher-acuity population with more complex care needs. When developing these rates, the Department must consider not just standard cost experiences, but also the specific care needs of PACE participants and any additional state plan services that are unique to the PACE program but not included in standard Medicaid managed care contracts. The bill replaces the previous language about rate development with this more nuanced approach, with the goal of ensuring more appropriate and accurate funding for PACE organizations that provide comprehensive care to elderly participants.
Committee Categories
Budget and Finance
Sponsors (1)
Last Action
Re-assigned to Appropriations- Health and Human Services (on 01/27/2026)
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=1804&GAID=18&DocTypeID=SB&SessionID=114&GA=104 |
| BillText | https://www.ilga.gov/legislation/104/SB/10400SB1804.htm |
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