Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 149 - DIAGNOSIS RELATED GROUPING (DRG) PROSPECTIVE PAYMENT SYSTEM (PPS)
Section 149.25 - General Provisions
Universal Citation: 89 IL Admin Code ยง 149.25
Current through Register Vol. 48, No. 38, September 20, 2024
Effective for dates of discharge on or after July 1, 2014:
a) Basis of Payment
1) Payment on a Per Discharge Basis
A) Under the DRG PPS, hospitals are paid a
predetermined amount per discharge for inpatient hospital services furnished to
persons receiving coverage under the Medicaid Program.
B) The DRG prospective payment rate for each
discharge (as defined in subsection (b)) is determined according to the
methodology described in Sections
149.100
and
149.150,
as appropriate. An additional payment is made, in accordance with Section
149.105,
as appropriate. The rates paid shall be those in effect on the date of
admission.
2) Payment in
Full
A) The DRG prospective payment amount
paid for inpatient hospital services is the total Medicaid payment for the
inpatient operating costs incurred in furnishing services covered under the
Medicaid Program.
B) Except as
provided for in Section
149.100(g),
the full DRG prospective payment amount, as determined under Section 149.100,
is made for each inpatient stay.
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