Ill. Admin. Code tit. 77, § 2060.318 - Reimbursement Rates and Rate Modification Methodology
a) Reimbursement rates for Department funding
and/or for services reimbursed through Medicaid are or have been developed
through the application of Department approved formal methodologies specific to
each reimbursable service. Unique to each service, a mean is then established
and a standardized rate adopted with the exception of provider specific rates
for certain residential and withdrawal management levels of care.
b) When an increase to an appropriation is
made specifically for a cost of living adjustment (COLA) to Department
established rates, the Department will increase all treatment provider service
rates by the same percent and all contract awards by the same corresponding
percent using the increased funds available, unless the appropriation results
in an increase of 1 percent or less to each individual provider, or an increase
of 1 percent or less for each category of service. If this occurs, increases to
established rates and awards will be made to one or more specific categories of
funded treatment/recovery service providers using the increased appropriations
available. All funded providers that deliver the selected service or services
will receive a uniform rate/award increase within their category of service.
Services targeted for increased rates or awards will be selected based on the
following criteria:
1) The amount of increase
to appropriated funds;
2) The need
for provider capacity enhancement or expansion;
3) Analysis of the impact of the rate
increase on other State agencies that fund substance use disorder
services;
4) Analysis of prior
State fiscal year earnings posted by vendor or location;
5) Based upon the analysis of earnings and
appropriated funds, a determination of the total value of the rate increase in
order to keep earnings liabilities within the available appropriation;
and
6) The ability of the
Department to continue the rate increase into future fiscal years if budget
requests are approved.
c) A general increase in an appropriation
that is not specified as a COLA shall be awarded according to the legislative
direction associated with the increase or by language in the budget
implementation plan for that State fiscal year. Increases of this nature may be
directed to a provider, a program, or another purpose by the General Assembly.
If a general appropriation increase exceeds the 1 percent parameters specified
in subsection (b) and the General Assembly provides no direction on how the
Department shall allocate the increase, the Department will modify all rates
and contract awards by the same percent.
d) All rates or rate modifications are
effective only after approval by the Department and, for covered services
reimbursed through Medicaid, the Illinois Department of Healthcare and Family
Services (HFS) in its capacity as the Medicaid single state agency.
e) Licensed/certified organizations and the
public shall be informed of any changes in the methods and standards of
determining reimbursement rates for services funded under this Part pursuant to
42
CFR 447.205 (2003).
Notes
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