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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 Outpatient Services

The Department of Healthcare and Family Services proposes to change the methods and standards by which certain Illinois hospitals are reimbursed for outpatient services 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 outpatient medical services. These changes will be effective with dates of service on or after January 1, 2007.

A hospital that qualifies for disproportionate share hospital adjustment payments for rate year 2007 as defined in Ill. Adm. Code148.120, has an emergency care percentage greater than 70% and has provided greater than 10,500 Medicaid outpatient ambulatory procedure listing services in the outpatient assistance base year will receive a payment rate of $139.00 multiplied by the number of Medicaid outpatient ambulatory procedure listing services provided in the outpatient assistance adjustment base year.

 

A general acute care hospital that qualifies for disproportionate share hospital adjustment payments for rate year 2007 as defined in Ill. Adm. Code 148.120, and has an emergency care percentage greater than 85% will receive a payment rate of $336.25 multiplied by the number of Medicaid outpatient ambulatory procedure listing services provided in the outpatient assistance adjustment base year.

For the payments listed above, the outpatient assistance adjustment base year means the 12-month period beginning on July 1, 2004, and ending June 30, 2005. It is estimated that these changes will result in an annual increase in Medicaid liability of $3.0 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. 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 local offices (except in Cook County) operated by the Department of Human Services. 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.