Hospital Rate Reform Initiative

The Department of Healthcare and Family Services is launching an important initiative to restructure and modernize the payment methodology for Medicaid inpatient and outpatient hospital rates. The sessions will be open forums to discuss the healthcare environment under Illinois’ new Medicaid reform law and the federal Affordable Care Act, key issues related to the current rate structure, a review of rate reform efforts in other states, and principles to incorporate in a new rate methodology. Technical sessions scheduled later will be available via videoconferencing at our offices in Springfield at 201 South Grand Avenue East and Chicago at 401 South Clinton. We will strive to involve stakeholders throughout this process.

• Inpatient
• Outpatient

• Inpatient Calculator Effective January 1, 2024 (xls)
• Inpatient Calculator Effective August 1, 2023 (xls)
• Inpatient Calculator Effective January 1, 2023 (xls)
• Inpatient Calculator Effective July 1, 2022 (xls)
  
• Inpatient Calculator Effective January 1, 2022 (xls)
• Inpatient Calculator Effective July 1, 2021 (xls)
• Inpatient Calculator Effective January 1, 2021 (xls)
• Inpatient Calculator Effective July 1, 2020 (xls)
• Inpatient Calculator Effective July 1, 2019 (xls)
• Inpatient Calculator Effective July 1, 2018 (xls)
  
• Inpatient Calculator Effective January 1, 2018 (xls)
• Inpatient Calculator Effective July 1, 2017 (xls)
• Inpatient Calculator Effective January 1, 2017 (xls)
• Inpatient Calculator Effective January 1, 2016 (xls)
• Inpatient Calculator Effective October 1, 2015 (xls)
• Inpatient Calculator Effective July 1, 2015 (xls)
  
• Inpatient Calculator Effective January 1, 2015 (xls)
  

• Outpatient Calculator Effective January 1, 2024 (xls)
• Outpatient Calculator Effective August 1, 2023 (xls)
• Outpatient Calculator Effective January 1, 2023 (xls)
• Outpatient Calculator Efffective July 1, 2022 (xls)
  
• Outpatient Calculator Effective January 1, 2022 (xls)
• Outpatient Calculator Effective July 1, 2021 (xls)
• Outpatient Calculator Effective January 1, 2021 (xls)
  
• Outpatient Calculator Effective July 1, 2020 (xls)
• Outpatient Calculator Effective July 1, 2019 (xls)
• Outpatient Calculator Effective March 8, 2019 (xls)
• Outpatient Calculator Effective July 1, 2018 (xls)
• Outpatient Calculator Effective January 1, 2018 (xls)
• Outpatient Calculator Effective July 1, 2017 (xls)
• Outpatient Calculator Effective January 1, 2017 (xls)
• Outpatient Calculator Effective July 1, 2016 (xls)
• Outpatient Calculator Effective January 1, 2016 (xls)
• Outpatient Calculator Effective October 1, 2015 (xls)
• FY 2016 Outpatient Calculator (xls)
• FY 2015 Outpatient Calculator (xls)

• Rate Reform Rule 146 (pdf)
  
• Rate Reform Rule 148 (pdf)
  

• Rate Reform Rules (pdf)
• Rate Reform Rules Comments Log (pdf)

• Hospital Reimbursement Reform Implementation Plan (pdf)

• Illinois Rate Reform Model Data Extract Walk-Through November 12, 2013 (mp3)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, April 17, 2013 Presentation and Handouts (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, March 27, 2013 Presentation and Handouts (pdf)
• Presentation to House Human Services Appropriations Committee, February 28, 2013 (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, January 29, 2013  Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, December 18, 2012  Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, March 29, 2012 Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, March 15, 2012 Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, March 1, 2012 Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, February 9, 2012 Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, January 18, 2012 Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, December 19, 2011 Presentation and Handout (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, October 28, 2011 (pdf)
• Illinois Medicaid Hospital Reimbursement Reform Technical Advisory Group Discussion of Design Considerations, September 22, 2011 (pdf)
• Illinois Medicaid Hospital Reimbursement Reform. Technical Advisory Group, Kick-Off Meeting, July 15, 2011, Presentation (pdf).
• The entire Hospital Validation of Cost Information Webinar that was conducted and recorded on July 6, 2011, is now available for review. You may need to install the Network Recording Player to review the Webinar. The link is available on the Webinar Web site as a free download.
• Healthcare and Family Services Inpatient and Outpatient Payment Reform, Project Overview and Design Framework (pdf)
• Centers for Healthcare Strategies Inc., Medicaid Payment Reform, Taking Center Stage in Washington & State Capitols (pdf)
• Presentation Entitled A Partnership for Reimbursement Reform (pdf)

• February 29, 2012 (pdf)

The Department has completed the Hospital Specific Cost Detail Worksheets. To obtain your facility’s worksheet, please email your request to HFS.Hospitals@illinois.gov. Please include your facility’s name(s) and MEDICARE ID number(s) in the request, as well as the email address to which you would like the worksheet sent.

• Revenue Code Cross Wall (xls)
• Revised Illinois Provider Cost Review (pdf)

• Deborah Bachrach, Special Counsel, Healthcare Transaction & Policy (pdf)
• John T. Bomher, Senior Vice President, Health Policy with the Illinois Hospital Association (pdf)
• Michael Nugent, Managing Director with Navigant's Healthcare Provider and Payer Practice (pdf)
• James B. Pettersson, Managing Director with Navigant Consulting, Inc. (pdf)
  

• Submit Your Comments and Questions