2005 Illinois Code - Chapter 320 Aging 320 ILCS 40/ All-Inclusive Care for the Elderly Act.
(320 ILCS 40/1)(from Ch. 23, par. 6901) Sec. 1. Short title. This Act may be cited as the All‑Inclusive Care for the Elderly Act. (Source: P.A. 87‑411.)
(320 ILCS 40/5)(from Ch. 23, par. 6905) Sec. 5. Legislative declaration. The General Assembly
finds and declares that it is the intent of this Act to replicate the
ONLOK program in San Francisco, California, that has proven to be
cost‑effective at both the state and federal levels. The PACE program is
part of a national replication project authorized in Section 9412(b)(2) of
the federal Omnibus Reconciliation Act of 1986, which
instructs the Secretary of the federal Department of Health and Human
Services to grant Medicare and Medicaid waivers to permit not more than 10
public or nonprofit private community‑based organizations in the country to
provide comprehensive health care services on a capitated basis to frail
elderly who are at risk of institutionalization. The General Assembly
finds that by coordinating an extensive array of medical and nonmedical
services, the needs of the participants will be met primarily in an
outpatient environment in an adult day health center, in their homes, or in
an institutional setting. The General Assembly finds that such a service
delivery system will enhance the quality of life for the participant and
offers the potential to reduce and cap costs to Illinois of the medical
needs of the participants, including hospital and nursing home admissions. The General Assembly declares that the purpose of this Act is to provide
services that would foster the following goals: To maintain eligible persons at home as an alternative to long‑term institutionalization; To provide optimum accessibility to various important social and
health resources that are available to assist eligible persons in
maintaining independent living; To provide that eligible persons who are frail elderly but who have the
capacity to remain in an independent living situation have access to the
appropriate social and health services without which independent living
would not be possible; To coordinate, integrate, and link these social and health services by
removing obstacles that impede or limit improvements in delivery of these
services; To provide the most efficient and effective use of capitated funds
for the delivery of these social and health services; To assure that capitation payments amount to no more than 95%
of the amount paid under the Medicaid fee‑for‑service structure
of an actuarially similar population. (Source: P.A. 87‑411.)
(320 ILCS 40/10)(from Ch. 23, par. 6910) Sec. 10. Services for eligible persons. Within the context of the
PACE program established under this Act, the Illinois Department of Public
Aid may include any or all of the services in Article 5 of the Illinois
Public Aid Code. An eligible person may elect to receive services from the PACE program.
If such an election is made, the eligible person shall not remain eligible
for payment through the regular Medicare or Medicaid program. All services
and programs provided through the PACE program shall be provided in
accordance with this Act. An eligible person may elect to disenroll from
the PACE program at any time. For purposes of this Act, "eligible person" means a frail elderly
individual who voluntarily enrolls in the PACE program, whose income and
resources do not exceed limits established by the Illinois Department of
Public Aid and for whom a licensed physician certifies that such a program
provides an appropriate alternative to institutionalized care. The term
"frail elderly" means an individual who meets the age and functional eligibility
requirements established by the Illinois Department of Public Aid. (Source: P.A. 94‑48, eff. 7‑1‑05.)
(320 ILCS 40/15)(from Ch. 23, par. 6915) Sec. 15. Program implementation. (a) Upon receipt of federal approval, the Illinois Department of Public
Aid shall implement the PACE program pursuant to the provisions of the approved Title XIX State plan. (b) Using a risk‑based financing model, the nonprofit organization providing
the PACE program shall assume responsibility for all costs generated by
the PACE program participants, and it shall create and maintain a risk
reserve fund that will cover any cost overages for any participant. The
PACE program is responsible for the entire range of services in the
consolidated service model, including hospital and nursing home care,
according to participant need as determined by a multidisciplinary team.
The nonprofit organization providing the PACE program is responsible for
the full financial risk. Specific arrangements of the risk‑based
financing model shall be adopted and negotiated by the federal Centers for Medicare and Medicaid Services, the nonprofit organization providing the PACE
program, and the Illinois Department of Public Aid. (Source: P.A. 94‑48, eff. 7‑1‑05.)
(320 ILCS 40/20)(from Ch. 23, par. 6920) Sec. 20. Duties of the Illinois Department. (a) The Illinois Department shall provide a system for reimbursement for
services to the PACE program. (b) The Illinois Department shall develop and implement a contract with the
nonprofit organization providing the PACE program that sets forth
contractual obligations for the PACE program, including but not limited to
reporting and monitoring of utilization of costs of the program as required
by the Illinois Department. (c) The Illinois Department shall acknowledge that it is participating
in the national PACE project as initiated by Congress. (d) The Illinois Department or its designee shall be responsible for
certifying the eligibility for services of all PACE program participants. (Source: P.A. 87‑411.)
(320 ILCS 40/25)(from Ch. 23, par. 6925) Sec. 25. Rules and regulations. The Illinois Department shall
promulgate rules and regulations necessary to implement this Act. (Source: P.A. 87‑411.)
(320 ILCS 40/30)(from Ch. 23, par. 6930) Sec. 30. Rate of payment. The General Assembly shall make
appropriations to the Illinois Department of Public Aid to fund services
under this Act provided at a monthly capitated rate. The Illinois
Department shall annually renegotiate a monthly capitated rate for the
contracted services based on the 95% of the Medicaid fee‑for‑service costs
of an actuarially similar population. (Source: P.A. 87‑411.)
Disclaimer: These codes may not be the most recent version. Illinois may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.