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Provider Notice issued 12/01/2023
| Date: | December 1, 2023 |
| To: | Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers |
| Re: | Updates to Hospital Reimbursement Components Effective January 1, 2024 Updates to Hospital Reimbursement Rates Effective January 1, 2024 |
Inpatient Rate Updates
In accordance with 89 Ill. Adm. Code Section 149.100, the Department is updating components of the inpatient reimbursement system including the Medicare IPPS wage index, Medicare IPPS labor share percentage, and cost to charge ratios. These updates will affect the base rates assigned to individual hospitals reimbursed under the APR-DRG grouper.
· For Medicare IPPS hospitals that are in-state or are out-of-state Medicaid cost-reporting hospitals, the wage index is based on the Medicare inpatient prospective payment system post-reclass wage index effective at the beginning of the federal fiscal year starting three months prior to the calendar year during which the discharge occurred.
·For in-state non-Medicare IPPS hospitals and out-of-state non-Medicaid cost-reporting hospitals, the wage index is based on the Medicare inpatient prospective payment system wage index for the hospital's Medicare CBSA effective at the beginning of the federal fiscal year starting three months prior to the calendar year during which the discharge occurred.
Updating the components listed above results in the following change to the APR-DRG standardized amount:
Current System 8.1.23 After Updated Wage Index, Labor Share, CCR
In-State Statewide Standardized Amount |
Total Outlier Payment |
Allowed Amount |
|
In-State Statewide Standardized Amount |
Total Outlier Payment |
Allowed Amount |
$3,519.72 |
$818,723,916 |
$2,404,545,708 |
|
$3,607.03 |
$773,380,084 |
$2,404,547,987 |
January 1, 2024, Inpatient Rate Increases
In accordance with Public Act 103-0102, the Department is posting rate increases for inpatient services effective with discharges on and after January 1, 2024. Fee-for-service rates will be implemented upon federal approval. The increases include:
·For inpatient general acute care services, a 10% increase to the state-wide standardized amount:
Unadjusted Standardized Amount 1.1.24 Standardized Amount
$3,607.03 $3,967.73
· For inpatient psychiatric, rehabilitation, long term acute care, and children’s specialty hospitals, individual hospital rates are listed in the provider rate sheets reflecting a 10% increase or an increase to the calculated minimum rates as described in the public act.
·New rate sheets effective 1.1.24 have been posted to the Department’s Hospital Reimbursement Notifications website.
·Updated inpatient calculators have been posted here.
Outpatient Rate Updates:
In accordance with 89 Ill. Adm. Code Section 148.140, the Department is updating components of the outpatient reimbursement system including the wage index, labor share percentage, and cost to charge ratios. These updates will affect the base rates assigned to individual hospitals reimbursed under the EAPG grouper.
Updating the components listed above results in the following changes to the EAPG standardized amounts:
Current System 8.1.23 After Updated Wage Index, Labor Share, CCR
COS |
In-State Statewide Standardized Amount |
Total Outlier Payment |
Allowed Amount |
In-State Statewide Standardized Amount |
Total Outlier Payment |
Allowed Amount |
24 |
$549.12 |
$128,989,340 |
$2,053,559,105 |
$543.10 |
$124,394,618 |
$2,054,310,221 |
27 & 28 |
$326.12 |
$14,642 |
$25,574,746 |
$326.94 |
$14,274 |
$25,573,351 |
29 |
$1,311.54 |
$216,147 |
$25,886,853 |
$1,311.43 |
$190,302 |
$25,878,874 |
January 1, 2024, Outpatient Rate Increases
In accordance with Public Act 103-0102, the Department is posting rate increases for outpatient services effective January 1, 2024. Due to federal upper payment limitations, government owned hospitals’ fee-for-service rates will not be increased; however, rates paid by HealthChoice Illinois MCO’s will contain the increases. Fee-for-service rates will be implemented upon federal approval.
Category of Service Unadjusted Standardized Amount 1.1.24 Standardized Amount
24 $543.10 $597.41
27 & 28 $326.94 $359.63
29 $1,311.43 $1,442.57
New rate sheets have been posted to the Department’s Hospital Reimbursement Notifications website.
Any further questions may be directed to the Bureau of Rate Development and Analysis at 217-785-0710.
Dan Jenkins, Deputy Administrator
Division of Medical Programs