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Full Text of HB2665
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HB2665 - 104th General Assembly
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104TH GENERAL ASSEMBLY
State of Illinois
2025 and 2026
HB2665
Introduced 2/6/2025, by Rep. Thaddeus Jones
SYNOPSIS AS INTRODUCED:
320 ILCS 40/16
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.
LRB104 09646 KTG 19712 b
A BILL FOR
HB2665
LRB104 09646 KTG 19712 b
1
AN ACT concerning public aid.
2
Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:
4
Section 5.
The Program of All-Inclusive Care for the
5
Elderly Act is amended by changing Section 16 as follows:
6
(320 ILCS 40/16)
7
Sec. 16.
Blended rate structure
Rates of payment
.
8
(a) The General Assembly shall make appropriations to the
9
Department to fund services under this Act.
To ensure that
10
organizations contracted to implement the PACE program meet
11
the needs of PACE participants, the Department shall reform
12
the rate-setting methodology for the PACE program by
13
establishing a blended rate structure based on a 30% Home and
14
Community-Based Services and 70% Skilled Nursing Facility
15
case-mix which is a more accurate proportion of the comparable
16
population expected to reside in an institution or the
17
community if not enrolled in PACE. The blended rate structure
18
established in accordance with this Section shall more
19
accurately reflect the comprehensive nature of care provided
20
by PACE organizations and address the unique needs of PACE
21
participants as a higher risk/acuity population with expected
22
higher costs and frailty than comparable populations.
23
When developing rates under the blended rate structure,
HB2665
- 2 -
LRB104 09646 KTG 19712 b
1
the Department must consider not only the standard cost
2
experiences of PACE participants but also the unique
3
characteristics and specific care needs of the PACE population
4
as well as any additional State plan services or populations
5
that are not included in the State's Medicaid managed care
6
contracts but are required under the PACE program.
The
7
Department shall develop and pay capitation rates to
8
organizations contracted to implement the PACE program as
9
described in Section 15 using actuarial methods.
10
The Department may develop capitation rates using a
11
standardized rate methodology across managed care plan models
12
for comparable populations. The specific rate methodology
13
applied to PACE organizations shall address features of PACE
14
that distinguishes it from other managed care plan models.
15
The
blended rate structure
rate methodology
shall be
16
consistent with actuarial rate development principles and
17
shall provide for all reasonable, appropriate, and attainable
18
costs for each PACE organization within a region.
19
(b) The Department may
develop statewide rates and
apply
20
geographic adjustments, using available data sources deemed
21
appropriate by the Department.
Consistent with actuarial
22
methods, the primary source of data used to develop rates for
23
each PACE organization shall be its cost and utilization data
24
for the Medical Assistance Program or other data sources as
25
deemed necessary by the Department. Rates developed under this
26
Section shall reflect the level of care associated with the
HB2665
- 3 -
LRB104 09646 KTG 19712 b
1
specific populations served under the contract.
2
(c) The
blended rate structure
rate methodology
developed
3
in accordance with this Section shall contain a mechanism to
4
account for the costs of high-cost drugs and treatments. Rates
5
developed shall be actuarially certified prior to
6
implementation.
7
(d)
(Blank).
Consistent with the requirements of federal
8
law, the Department shall calculate an upper payment limit for
9
payments to PACE organizations. In calculating the upper
10
payment limit, the Department shall collect the applicable
11
data as necessary and shall consider the risk of nursing home
12
placement for the comparable population when estimating the
13
level of care and risk of PACE participants.
14
(e)
(Blank).
The Department shall pay organizations
15
contracted to implement the PACE program at a rate within the
16
certified actuarially sound rate range developed with respect
17
to that entity as necessary to mitigate the impact to the
18
entity of the methodology developed in accordance with this
19
Section.
20
(f) This Section shall apply for rates established
on and
21
after the effective date of this amendatory Act of the 104th
22
General Assembly.
no earlier than July 1, 2022.
23
(Source: P.A. 102-43, eff. 7-6-21.)
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