Table 3. Summary of PACE Rate-Setting Methodologies for Medicaid by State.

State	Rate-Setting is Based on:	Per Member per Month Rates
California	State's expenditures for a nursing facility population in comparable geographic area, age, and sex adjusted to match PACE program's enrollment. The rate is discounted 15 percent.	1$1,988
Colorado	Net costs to the State of nursing facility and home and community-based services populations (weighted based on current distribution of LTC enrollees, which is 82 percent nursing facility/18 percent home and community-based services).  The rate is discounted 5 percent.	1,486
Hawaii	State expenditures for the nursing facility population.	2,100
Illinois	Based on blended average of costs of nursing facility and home and community-based services populations (weighted 75 percent nursing facility/25 percent home and community-based services)	1,588
Massachusetts	Blended average of nursing facility and home and community-based services.	2,044
Maryland	Blended average of the total costs to the State for 3 population groups: nursing facilitiy (30 percent), adult day care (60 percent), and other home and community-based services (10 percent). State has developed 4 separate rates based on eligibility for Medicare and Supplemental Security Income.	11,781
Michigan	FFS costs of a nursing facility population institutionalized for the full year. State is currently reviewing methodology.	1,841
New Mexico	95 percent of net nursing facility costs plus prescription drug costs for nursing facility population. The net nursing facility costs are reduced by 5 percent.	2,046
New York	Initial rates are based on FFS costs of nursing facility and comparable LTC populations. Subsequent rates take into consideration two major components: plan's projected operations and FFS equivalent.	1,23,965 32,298
Ohio	FFS costs of nursing facility and home and community-based services recipients weighted based on their distribution in the service area. The rate is discounted by 5 percent.	2,296
Oregon	Assisted living facility rate plus average acute care costs of assisted living facility population plus $13 enrollment fee. The assisted living facility rate is discounted by 5 percent.	1,706
Pennsylvania	Statewide average costs (net expenditures) for a nursing facility population. The rate is discounted by 5 percent.	2,473
South Carolina	State's net expenditures for a nursing facility population in a comparable geographic area. The rate is discounted by 5 percent.	2,021
Texas	Average nursing facility rates weighted by El Paso County nursing facility case mix distribution, less the average statewide applied income plus actual average additional expenditures for nursing facility population. The rate is discounted by 5 percent.	1,819
Virginia	Costs for all LTC populations. An adjustment was made to reduce the weighting for those who were 100 percent skilled nursing facility. State plans to use 6 rates based on aid code and Medicare eligibility. The rate is discounted by 5 percent.	1,824
Washington	Total costs of care for nursing facility residents in King County--those in a nursing facility for 3 or moremonths in the year. The rate is discounted by 5 percent.	3,096
Wisconsin	Three components: the average nursing facility rate less the average statewide recipient nursing facility liability, plus the average additional costs for the nursing facility population. Nursing facility component blended skilled nursing facility/intermediate care facility based on PACE site's actual enrollee mix. Other costs are adjusted for age mix of enrollees as well. The rate is discounted by 5 percent.	2,153

¹Average.

²Bronx.

³Rochester.

NOTES: In some States, the actual payments to these programs are reduced by the Medicaid enrollee's average share of cost. PACE is Program of All-Inclusive Care for the Elderly. LTC is long-term care. FFS is fee-for-service.

SOURCE: Adapted from (Iversen and Shen, 1996).