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Elizabeth M. Whitehorn, Director

Hospital Rate Reform Initiative

Overview

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.

For MCO DRG- and EAPG-based payments to safety-net hospitals as classified by the Department or critical access hospitals that do not have their own Medicaid claim-pricing software, the Department, on receipt of a request sent to HFS.Hospitals@illinois.gov will provide the hospital's appropriate staff a report with reasonably complete data for the most recent quarter's paid claims that is available. This data is intended to show what the hospital was paid by the MCO for specific services and what HFS would have paid for those services under its fee-for-service system based on the information the MCO sent HFS (which might not include all information in the MCO's EOP) and that system's programmed rates for the claim (which might not yet reflect all rate updates depending on the timing of the data). Whether or not a hospital should have been paid what fee-for-service would have paid would be determined by the contract between the hospital and the MCO.

Rate Reform Questions and Answers

Pricing Calculators

Inpatient

Outpatient

Archived Pricing Calculators

Proposed Additional Rate Reform Rules published March 21, 2014

Hospital Rate Reform Rules

Implementation Plan

Presentations

Illinois Hospital Rate Reform Questions and Answers

Hospital Rate Reform Resources

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.

BIOs for the Presenters

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