MEDICAID OPTION-PACE SERVICES

Amends the All-Inclusive Care for the Elderly Act. Changes the name of the Act to the "Program of All-Inclusive Care for the Elderly Act". Provides that no later the March 1, 2022, the Department of Healthcare and Family Services must submit a State Plan amendment to the federal Centers for Medicare and Medicaid Services (CMS) to establish the Program of All-Inclusive Care for the Elderly (PACE program) to provide community-based, risk-based, and capitated long-term care services as optional services under the State's Medicaid Plan and under contracts entered into between CMS, the Department, and PACE organizations. Provides that beginning June 1, 2022, or upon federal approval, the Department must develop the PACE program in consultation with nursing homes, Area Agencies on Aging, and others interested in the well-being of Illinois' elderly residents. Provides that no later than June 30, 2022, the Department must have prepared a comprehensive plan that describes on a county by county basis how PACE services will be delivered within the designated region. Requires the Department, by August 1, 2022, to issue a request for proposals seeking organizations to enter into risk-based contracts. Provides that no later than October 1, 2023, the Department shall begin accepting applications for the PACE program and shall begin approving applications by November 1, 2023. Provides that certain federal requirements of the PACE model shall not be waived or modified. Contains provisions concerning the treatment of income and resources to determine applicant eligibility; capitation rates for PACE organizations; and other matters. Amends the Illinois Public Aid Code. Provides that subject to federal approval, PACE services shall become a covered benefit of the medical assistance program. Effective immediately. Fiscal Note (Dept. of Healthcare & Family Services) The Department of Healthcare and Family Services anticipates that approximately 3 - 6 PACE organizations would begin operation between a target start date of 7/1/23 and a target end date of 6/30124. II is anlicipated that capacity at each center would be roughly 500 individuals. At a per member per month rate of $616 the cost would be between $924,000 and $1,848,000. This fiscal impact has been put together with very broad assumptions, as at this point, ii is difficult to detennine exactly how many areas of the state will be able to support a PACE program, and thus, the number of enrollees is a very general estimate. It is important to note, the cost of the PACE program would be offset by the reduction to MCO coverage. Therefore, while there is a fiscal impact, the fiscal impact on the state overall would be minimal.