Skip to main content
  • Notice of Privacy Incident
  • Medicaid Provider Termination Alert: Revalidation deadlines are approaching. Failure by providers to revalidate will lead to termination and payment suspension. Check your account now at https://impact.illinois.gov/ to learn if your required revalidation is due this month. More revalidation information here.
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 Inpatient 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 these classes of providers are consistent with the State’s fiscal year 2007 budget while maintaining access to necessary inpatient medical services. These changes will be effective with dates of service on or after January 15, 2007.

The department proposes to amend the Illinois Title XIX State plan, and the provisions of 89 Ill. Adm. Code 148.126, Safety Net Adjustment Payments (SNAP), in order to establish new qualification criteria. The proposed change will allow hospitals to qualify if, in the safety net base year, all of the following are met: (1) the hospital did not already qualify for the program; (2) has a combined Medicaid inpatient utilization rate greater than 28%; (3) is designated a perinatal level II center by the Illinois Department of Public Health; (4) has more than 320 licensed beds; (5) has an occupancy rate greater than 37%; and, (6) has an average length of stay less than 3.1 days.

In addition, the department proposes to increase various rates under the SNAP program:

  • 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 $125.00 to $255.50.

  • Section 148.126(c)(1)(I)(vii): For a hospital with more than 700 licensed beds, the rate will be increased from $37.75 to $57.25.

  • Section 148.126(c)(2): For a hospital qualifying under subsection (a)(2), the rate will be increased from $123.00 to $154.50.

  • Section 148.126(c)(6): For a hospital qualifying under subsection (a)(6), the rate will be increased from $53.00 to $149.00.

  • Section 148.126(c)(7): For a hospital qualifying under subsection (a)(7), the rate will be increased from $175.50 to $322.50.

  • Section 148.126(c)(10): For a hospital qualifying under subsection (a)(10), the rate will be increased from $13.75 to $96.25.

  • Section 148.126(c)(13): For a hospital qualifying under subsection (a)(13) of this Section, the rate will be increased from $231.50 to $365.00.

  • Section 148.126(c)(14): For a hospital qualifying under subsection (a)(14), the rate will be increased from $172.00 to $430.00.

  • Section 148.126(c)(15): For a hospital qualifying under subsection (a)(15), the rate is $540.00

The department proposes to amend the Critical Hospital Adjustment Payments (CHAP). For hospitals that qualify under section 89 Ill. Adm. Code 148.295 (c)(2)(H): (1) hospitals with a Medicaid inpatient utilization rate (MIUR) equal to or less than 19.75%, will receive a rate of $11.00 per day; (2) hospitals with an MIUR greater than 19.75%, but equal to or less than 20.00% will receive a rate of $69.00 per day; and, (3) hospitals with an MIUR greater than 20.00% will receive a rate of $110.00 per day.

It is estimated that these changes to the SNAP and CHAP quarterly payment programs will result in an annual increase in Medicaid liability of $27.2 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.