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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 (HFS) proposes to change the methods and standards by which certain services are reimbursed under the Illinois Medical Assistance program, contingent upon the final disposition of the FY2008 Budget Implementation Act (SB 0783). HFS proposes to amend the Illinois Title XIX (Medicaid) State plan to effect the changes listed below. These changes are being made in order to assure that reimbursement for services is consistent with the State’s fiscal year 2008 budget while maintaining access to necessary medical services. Depending upon the final disposition, these proposed changes would be effective January 1, 2008.

Hospital Services

    • Cost outlier payments. Increase, from 1.47 to 1.64 the factor used for cost outlier payments made to hospitals reimbursed under the diagnosis related grouping prospective payment system.  Decrease, from 0.18 to 0.17 for cost outlier payments made to hospitals reimbursed under the per diem payment systems. Implementation of these changes will decrease liability approximately $20 million for State fiscal year 2008.

    • Allow cost-reporting hospitals licensed by the Department of Public Health (or a similar authority in another state) as a pediatric hospital to qualify for outlier payments on recipients who have not attained 19 years of age. Implementation of this change will increase liability approximately $2 million for State fiscal year 2008. 

Long Term Care Services

  • Recalculate the support component of the reimbursement rate paid to nursing facilities using the most recent cost reports from each facility that were on file with the HFS as of April 1, 2005, updated for inflation to January 1, 2006. This will result in an average increase of about 5 percent in the per diem rate. Implementation of this change will increase liability by approximately $50 million for State fiscal year 2008.

  • Increase reimbursement for nursing facilities that are reimbursed under the minimum data set methodology. Reimbursement for such facilities shall be affected by recomputing the nursing component of the rate and slightly adjusting the case-mix calculation, resulting in an average increase of 2.4 percent.  Implementation of this change will increase liability by approximately $25 million for State fiscal year 2008.

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.