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Elizabeth M. Whitehorn, Director

Proposed Changes In Methods And Standards

State of Illinois Healthcare and Family Services

Proposed Changes in Methods and Standards for Establishing Medical Assistance Payment Rates for Certain Services

The Department of Healthcare and Family Services proposes to change the methods and standards by which certain Illinois hospitals are reimbursed for inpatient services under the Illinois Medical Assistance program. These changes are being made in order to assure that reimbursement for services rendered by this class of providers is consistent with the State’s fiscal year 2008 budget while maintaining access to necessary inpatient medical services. These changes will be effective with dates of service on or after February16, 2008.

The Department proposes to amend 89 Ill. Admin. Code 148.126, Safety Net Adjustment Payments (SNAP), in order to establish a new qualification criterion. The proposed change will allow a hospital to qualify if, in the safety net base year, the hospital had a Medicaid Inpatient Utilization Rate greater than 90%.

In addition, the department proposes to increase various rates under the SNAP program. These include the following:

  • Section 148.126(c)(1)(G): For a children’s hospital with more than 25 graduate medical education programs, as listed in the “2000-2001 Graduate Medical Education Directory,” the rate will be increased from $255.50 to $290.75.

  • Section 148.126(c)(1)(K): A qualifying hospital that provided greater than 35,000 total days in the safety net hospital base year, the rate will be increased from $6.00 to $43.25.

  • Section 148.126(c)(14): For a hospital qualifying under subsection (a)(14) of this Section, the rate will be increased from $430.00 to $601.75.

  • Section 148.126(c)(16): For a hospital qualifying under subsection (a)(17) of this Section, the rate is $39.50.

It is estimated that these changes to the SNAP quarterly payment programs will result in an annual increase in Medicaid liability of $7.7 million.

Time, place and manner in which interested persons may comment on the proposed changes:

Any interested party may submit comments, data, views, or arguments concerning these proposed changes. All comments must be in writing and should be addressed to:

Bureau of Program and Reimbursement Analysis
Division of Medical Programs
Healthcare and Family Services
201 South Grand Avenue East
Springfield, Illinois 62763-0001
E-mail address: hfs.webmaster@illinois.gov

Interested persons may review these proposed changes on the Internet at HFS Public Notices. Local access to the Internet is available through any local public library. In addition, this material may be viewed at the DHS local offices (except in Cook County). In Cook County, the changes may be reviewed at the Office of the Director, Healthcare and Family Services, 100 West Randolph Street, Chicago, Illinois. The changes may be reviewed at all offices Monday through Friday from 8:30 a.m. until 5 p.m. This notice is being provided in accordance with federal requirements found at 42 CFR 447.205.