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SB1804 • 2026
DHFS-PACE-RATE REFORM
This bill passed both chambers and reached final enrollment, even if later executive action is not shown here.
Using official source text because the generated explanation was unavailable or could not be confirmed against the official bill text.
DHFS-PACE-RATE REFORM
Rule 3-9(a) / Re-referred to Assignments
Rule 2-10 Committee/3rd Reading Deadline Established As May 22, 2026
Rule 2-10 Committee/3rd Reading Deadline Established As May 15, 2026
Rule 2-10 Committee Deadline Established As April 24, 2026
Re-assigned to Appropriations- Health and Human Services
Rule 3-9(a) / Re-referred to Assignments
Rule 2-10 Committee/3rd Reading Deadline Established As June 1, 2025
Rule 2-10 Committee/3rd Reading Deadline Established As May 23, 2025
Rule 2-10 Committee Deadline Established As May 9, 2025
Rule 2-10 Committee Deadline Established As April 11, 2025
Assigned to Appropriations- Health and Human Services
Filed with Secretary by Sen. Ram Villivalam
First Reading
Referred to Assignments
DHFS-PACE-RATE REFORM
Illinois General Assembly - Full Text of SB1804 Select Language × The Illinois General Assembly offers the Google Translate™ service for visitor convenience. In no way should it be considered accurate as to the translation of any content herein. Visitors of the Illinois General Assembly website are encouraged to use other translation services available on the internet. The English language version is always the official and authoritative version of this website. NOTE: To return to the original English language version, select the "Show Original" button on the Google Translate™ menu bar at the top of the window. 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Full Text of SB1804 Home Legislation Full Text SB1804 - 104th General Assembly Bill Status Full Text Votes Witness Slips Select Menu Bill Status Full Text Votes Witness Slips Printer Friendly Version Introduced Printer Friendly Version Introduced Open PDF 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1804 Introduced 2/5/2025, by Sen. Ram Villivalam 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 07669 KTG 17713 b A BILL FOR SB1804 LRB104 07669 KTG 17713 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, SB1804 - 2 - LRB104 07669 KTG 17713 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 SB1804 - 3 - LRB104 07669 KTG 17713 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.) Footer Disclaimer This site is maintained for the Illinois General Assembly by the Legislative Information System, 705 Stratton Building, Springfield, Illinois 62706. 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