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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 Non-Institutional Services

The Department of Healthcare and Family Services (HFS) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medical Assistance program.  These changes are being made in order to assure that reimbursement for services rendered by these classes of providers are consistent with the State’s fiscal year 2007 budget while maintaining access to necessary medical services. 

Critical Hospital Adjustment Payments

Effective for dates of service on or after July 1, 2007, the HFS proposes to change the way certain hospitals are reimbursed for Trauma Center Payments.  For hospitals in the same city that rotate their Level I Trauma Center designation, the department will modify qualifying and payment criteria to coincide with the timing in which the Level I Trauma Center designation changes from one hospital to the other.  The HFS also proposes to change the way certain hospitals are reimbursed for Direct Hospital Adjustment Payments.  The proposed change will modify the payment methodology under Section 148.295(c)(3)(H) by reducing from three to two payment rates for hospitals qualifying under the section.  These proposed changes are technical modifications that in aggregate will have no budgetary impact.

Program for all-inclusive care for the elderly (PACE)

Effective with contracts beginning on or after July 1, 2007, the HFS proposes to change the claims history base period for determining the maximum monthly reimbursement for the program to the most recent State fiscal year for which complete data are available.  Currently, the base period is the State fiscal year ending no more recently than six months prior to this determination.  This change will provide a more accurate determination by eliminating the need to estimate liability incurred but not reported.

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.  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.