Ill. Admin. Code tit. 89, § 148.421 - Hospital Inpatient Adjustment

a) Qualifying Criteria. Effective July 1, 2020, the following categories of non-large public hospitals located in Illinois shall qualify for a Hospital Inpatient Adjustment Payment:

1) General Acute Care Hospitals (see definition of "Hospital" in Section 148.25);

2) Safety-Net Hospitals, as defined in subsection (c)(2);

3) Long Term Acute Care (LTAC) Hospitals, as defined in Section 148.25;

4) Psychiatric Hospitals, as defined in Section 148.25(d)(1);

5) Rehabilitation Hospitals, as defined in Section 148.(d)(2); and

6) Critical Access Hospitals, as defined in 42 CFR 485, Subpart F.

b) Payment. Each qualifying hospital shall receive an annual payment equal to the product of:

1) The hospital's calendar year 2019 inpatient days; and

2) The rate assigned to the group to which the hospital qualifies:

A) General Acute Care Hospitals: $350;

B) Safety-Net Hospitals: $960;

C) LTAC Hospitals: $295;

D) Psychiatric Hospitals: $125;

E) Rehabilitation Hospitals: $355; and

F) Critical Access Hospitals: $385.

c) Definitions. For purposes of this Section:

1) "Inpatient days" means, for a given hospital, the sum of fee-for-service inpatient hospital days provided to recipients of medical assistance under Title XIX of the Social Security Act for general acute care, psychiatric care, and rehabilitation care, excluding days for individuals eligible for Medicare under Title XVIII of the Social Security Act (Medicaid/ Medicare crossover days), as tabulated from the Department's paid claims data for total days occurring during calendar year 2019 as of May 11, 2020.

2) "Safety-Net Hospital" means a hospital, as defined in 89 Ill. Adm. Code 149.100(f)(4), except that stand-alone children's hospitals that are not specialty children's hospitals will not be included.

Notes

Ill. Admin. Code tit. 89, § 148.421

Added at 44 Ill. Reg. 19767, effective 12/11/2020