Provider Notice issued 09/02/2005

This bulletin notifies hospitals of a change to the cost outlier payment calculation for admissions occurring on and after July 1, 2005. This change affects hospitals

reimbursed by DRG and per diem reimbursement methodologies and is a result of anamendment to 89 Illinois Administrative Code Section 152.

For DRG-reimbursed hospital services with admissions on and after July 1, 2005, the Specific Fixed Loss Threshold used in the cost outlier payment calculation will be

multiplied by 1.40. The DRG outlier payment calculation is shown in Appendix H-22f, page 4 in the Handbook for Hospitals. For per diem-reimbursed hospital services with admissions on and after July 1, 2005, a factor of 0.20 will be used in the outlier payment calculation. The outlier payment calculation for per diem-reimbursed hospitals is shown in Appendix H-22f, pages 4a and 4b. This bulletin and the replacement handbook pages may be obtained from the department’s Web site at: <http://www.hfs.illinois.gov/>. The revisions in the replacement pages are identified by an “=” to the left of the affected text. Paper copies of the revised pages may be obtained by written request. To ensure delivery, you must specify a physical street address when requesting a paper copy.

You may submit your written request to the address below, or fax or e-mail it as noted:

Healthcare and Family Services

Provider Participation Unit

Post Office Box 19114

Springfield, Illinois 62794-9114

Fax Number: (217) 557-8800 / E-Mail Address: PPU@idpa.state.il.us

As you can see, the name of the Department of Public Aid (DPA) has changed to Healthcare and Family Services (HFS). You will see the new name on forms, letters and the Internet. Until existing form supplies are exhausted, we will continue to use materials bearing the former DPA name and logo. Either version of documents should be considered official regardless of the name they bear.

Only our name has changed. HFS’s programs, staff, office locations, mailing addresses and phone numbers remain the same as DPA’s. We believe our new name more

clearly reflects our mission of service to the State of Illinois including providing access to health care for over two million Illinoisans. We deeply appreciate your participation in our programs and we hope this change poses no inconvenience for you. Providers wishing to receive e-mail notification, when new provider information has been  posted by the department, may register at the following HFS Web site:

http://www.hfs.illinois.gov/provrel

Instructions for updating the Handbook for Hospitals:

Remove appendix page H-22f (4) dated December 2001 and replace with the updated page (4) dated August 2005.

Remove appendix pages H-22f (4a) and (4b) dated December 2001 and replace with the updated pages (4a) and (4b) dated August 2005.