Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 148 - HOSPITAL SERVICES
Subpart B - REIMBURSEMENT AND RELATED PROVISIONS
Section 148.115 - Reimbursement Methodologies for Long Term Acute Care Services
Current through Register Vol. 48, No. 12, March 22, 2024
Effective with discharges on or after July 1, 2014:
a) Inpatient long term acute care psychiatric services excluded from the DRG PPS pursuant to 89 Ill. Adm. Code 149.50(b) shall be reimbursed under the inpatient psychiatric services methodologies specified in Section 148.110.
b) Inpatient long term acute care services excluded from the DRG PPS shall be reimbursed a hospital-specific rate paid per day of covered inpatient care, determined pursuant to this Section. The total payment for an inpatient stay will equal the sum of:
c) Payment for long term acute care services provided by a long term acute care hospital, as defined in Section 148.25(d)(4):
d) The hospital-specific rate is calculated as the sum of:
e) Definitions
"Allocated static payments" means the adjustment payments made to the hospital pursuant to Sections 148.105, 148.115, 148.126, 148.295, 148.296 and 148.298 during SFY 2011 pursuant to the methodologies outlined in rule as of February 21, 2014 (see http://www2.illinois.gov/hfs/PublicInvolvement/hospitalratereform/Pages/Rules.aspx), as determined by the Department, allocated to long-term acute care services based on the ratio of long-term acute care claim charges, excluding psychiatric claim charges, to total inpatient claim charges determined using inpatient base period claims data.
"Inpatient base period paid claims data" means SFY 2011 inpatient Medicaid fee-for-service paid claims data, excluding Medicare dual eligible claims.
f) Long Term Acute Care Supplemental Per Diem Rates.
g) Effective for dates of service on and after July 1, 2018, rates in this Section are increased by 10.5 percent.