Current through Register Vol. 48, No. 12, March 22, 2024
Effective for dates of service starting July 1, 2018, except
when specifically designated otherwise in this Section:
a) Inpatient Graduate Medical Education (GME)
Payment
1) Definitions. As used in this
Section, unless the context requires otherwise:
A) "Medicare cost report" means the Medicare
cost report ending in 2015, as reported in Medicare cost reports released on
October 19, 2016, with data through September 30, 2016.
B) "Hospital's Annualized Medicaid Inpatient
Intern Resident Cost" is the product of the following factors:
i) Annualized intern and resident costs
obtained from Worksheet B Part I, Column 21 and 22 the sum of Lines 30 through
43, 50 through 76, 90 through 93, 96 through 98, and 105 through112;
ii) A quotient of:
* The numerator of which is the hospital's Medicaid days
(Worksheet S3 Part I, Column 7, Lines 2 through 4, 14, 16 through 18, and 32);
and
* The denominator of which is the hospital's total days
(Worksheet S3 Part I, Column 8, Lines 14 and 16 through18);
and.
iii) The quotient of:
* The numerator of which is the hospital's total inpatient
charges; and
* The denominator of which is the hospital's total
charges.
C)
"Hospital Annualized Medicaid Indirect Medical Education (IME) Payment" is the
product of the following factors:
i) Hospital
IME payments (Worksheet E Part A, Line 29, Col 1); and
ii) The quotient of:
* The numerator of which is the hospital Medicaid days
(Worksheet S3 Part I, Column 7, Lines 2 through 4, 14, 16 through 18, and 32),
and
* The denominator of which is the hospital Medicare days
(Worksheet S3 Part I, Column 6, Lines 2 through 4, 14, and 16 through
18).
2) Qualifying Criteria: An Illinois large
public hospital reporting intern and resident cost on its Medicare cost report
ending in 2015 shall be eligible for an inpatient GME payment.
3) Payment. A qualifying large public
hospital shall receive a payment that is the sum of each large public
hospital's annualized Medicaid Intern Resident Cost and annualized Medicaid IME
payment.
4) Effective July 1, 2020,
payment amounts in this subsection (a) may be calculated annually, or at least
every 3 years, using updated Medicare Cost Report information. Updated Medicare
Cost Report information shall be the most recent Medicare Cost Report available
as of October of the calendar year preceding the SFY.
b) Outpatient (GME) Payment
1) Definitions. As used in this Section,
unless the context requires otherwise:
A)
"Medicare Cost Report" means the Medicare cost report ending in 2015, as
reported in Medicare cost reports released on October 19, 2016, with data
through September 30, 2016.
B)
"Hospital's Annualized Medicaid Outpatient Intern Resident Cost" is the product
of the following factors:
i) Annualized intern
and resident costs obtained from Worksheet B Part I, Column 21 and 22 the sum
of Lines 30 through 43, 50 through 76, 90 through 93, 96 through 98, and 105
through 112; and
ii) A quotient of:
* the numerator of which is the hospital's Medicaid days
(Worksheet S3 Part I, Column 7, Lines 2 through 4, 14, 16 through 18, and 32);
and
* the denominator of which is the hospital's total days
(Worksheet S3 Part I, Column 8, Lines 14 and 16 through 18);
and
C) The
quotient of:
i) The numerator of which is the
hospital's total outpatient charges; and
ii) The denominator of which is the
hospital's total charges.
2) Qualifying Criteria: A large public
hospital reporting intern and resident cost on its Medicare cost report ending
in 2015 shall be eligible for a outpatient graduate medical education
payment.
3) Payment. A qualifying
large public hospital shall receive an outpatient GME payment that is equal to
subsection (d)(2).
4) Effective
July 1, 2020, payment amounts in this subsection may be calculated annually, or
at least every 3 years, using updated Medicare Cost Report information. Updated
Medicare Cost Report information shall be the most recent Medicare Cost Report
available as of October of the calendar year preceding the SFY.
