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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 (HFS) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medical Assistance Program, pursuant to implementation of the Illinois State fiscal year 2011 budget.

Effective for dates of service on or after October 1, 2010, the Illinois Title XIX State plan will be amended to incorporate the following changes:

The department anticipates calculating the inpatient and outpatient payments for government-owned hospitals by using a hospital specific inflator rather than the CMS Hospital Price Index. It is estimated that this change will increase the department's ability to increase the amount of federal funds received for Medicaid service provided at government hospitals. For the federal fiscal year beginning October 1, 2010, the additional federal revenue is estimated to be about $50 million.


Pursuant to Public Act 96-1130 (pdf), the department will calculate a supplemental per diem rate for qualifying Long Term Acute Care Hospitals. The supplemental rate will be based upon the hospital's costs, less other Medicaid payments received as defined in the Act. The intent of Public Act 96-1130 is to improve the health outcomes of certain Medicaid patients by encouraging the use of the most appropriate hospital setting. Payments will be made for certain patients that are transferred from acute care hospitals to qualifying long term stay hospitals, under conditions established by the department. It is estimated that these new payments will increase annual expenditures by approximately $10 million. However, these costs are anticipated to be offset by reducing the length of stay in general acute care hospitals.


The department anticipates changing the conditions under which public schools and local health departments may be reimbursed for Medicaid services. The federal Centers for Medicare and Medicaid Services has long held that services provided by such governmental entities is limited to services otherwise funded through Title V or services that are defined as part of a child's Individual Education Plan. A federal appeal board ruled against such limitations and the department will file a State Plan amendment to eliminate such restrictions. The department estimates that such a change will increase the availability of federal funds by $5 million to $10 million, depending on the volume of claims submitted.

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 62763-0002

E-mail address: 

Interested persons may review these proposed changes on the Internet 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.