Provider Notice Issued 04/02/2021

Date:     April 2, 2021

To:       Participating Hospitals:  Chief Executive Officers; Chief FinancialOfficers; and Patient Accounts Managers

Re:      Hospital Long Term Care Days Reimbursement

This notice informs hospitals of a payment mechanismwhen continued hospitallevel of care is no longer necessary and discharge of the patient is delayeddue to the lack of available placement outside of the hospital at the nextlevel of care. This applies only to inpatient claims forservices paid under the Department’s fee-for-service program and is notapplicable to services provided to patients covered by a HealthChoiceIllinois managed care plan.

Pursuant to 89Ill. Admin. Code Section 148.50, the Department will considerreimbursement for days that are not covered by the hospital inpatient stay butwhere discharge is not allowable due to the inability to place the patient in alower level of care. These days are identified in the rule as hospital longterm care days.

Process for RequestingHospital Long Term Care Days

            · A hospital must make fiveattempts to place the patient in a lower level of care prior to contacting theDepartment to apply for hospital long term care days reimbursement. If theattempts are unsuccessful, hospitals must complete FormHFS 1329 and submit it via email to hfs.Hospitals@illinois.gov. Hospitals are reminded that the completed form contains protectedhealth information and HIPAA privacy guidelines should be followed whenemailing the form. Please note, only days that occur on and after the date ofform submittal will be considered for reimbursement. For general acute carestays that are reimbursed under the DRG system, only days that exceed theaverage length of stay for that DRG will be considered for reimbursement. 

             ·  An admission throughdischarge DRG-reimbursed claim or the final claim of a per diem reimbursed stay,both of which must identify the non-covered hospital long term care days,should be submitted to the Department via the usual process. Department staffwill monitor the claim adjudication and when the claim is in paid status, willreview FormHFS 1329 and calculate the number of eligible hospitallong term care days. Each approved hospital long term care day will bereimbursed at $289.48.

             · The Department willgenerate an adjustment for the hospital long term care days payment. An AdjustmentReason Code in the sequence of 8548 through 8555 with description “ReimburseHosp LTC Days” will be identified on the Remittance Advice.

Hospitals may submit FormHFS 1329 for claims with dates of admission beginning July1, 2019. For claims where the date of admission is prior to April 1, 2021, hospitallong term care days will be reimbursed for all claims where a form is receivednoting the five attempted placements, a claim is on file with the Departmentwith non-covered days reported, and for acute care claims reimbursed under theDRG system, the administrative days exceed the average length of stay. For theadmission period above, the payment limitation to only days on or afternotification is received by the Department is not applicable. 

Questions may be directed to a hospital billingconsultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

Kelly Cunningham, Administrator

Division of Medical Programs

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