IL SB1804

Reforms the rate-setting methodology for the Program of All-Inclusive Care for the Elderly (PACE) by establishing a blended rate structure of 30% Home and Community-Based Services and 70% Skilled Nursing Facility case-mix

Requires the Department of Healthcare and Family Services to develop rates that reflect PACE participants' higher risk, acuity, and frailty compared to other populations

Mandates consideration of unique characteristics, specific care needs, and additional State plan services required under PACE but not included in standard Medicaid managed care contracts when setting rates

Eliminates previous provisions allowing the Department to develop standardized capitation rates using actuarial methods based on each organization's cost and utilization data

Removes the requirement to calculate an upper payment limit and pay within a certified actuarially sound rate range, replacing these with the new blended rate structure