Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 149 - DIAGNOSIS RELATED GROUPING (DRG) PROSPECTIVE PAYMENT SYSTEM (PPS)
Section 149.50 - Hospital Inpatient Services Subject to and Excluded from the DRG Prospective Payment System
Universal Citation: 89 IL Admin Code ยง 149.50
Current through Register Vol. 48, No. 12, March 22, 2024
Effective for dates of discharge on or after July 1, 2014:
a) Inpatient Services Subject to Submission for DRG Grouping. All hospital inpatient services provided to enrollees of the Medical Assistance programs, without regard to balance due or expected reimbursement methodology to be applied by the Department, must be documented on a claim and submitted to the Department. The Department shall process and group all hospital inpatient claims through the DRG grouper.
b) Excluded from DRG PPS reimbursements are:
1) Psychiatric services
provided by:
A) A psychiatric hospital, as
described in 89 Ill. Adm. Code
148.25(d)(1).
B) A distinct part psychiatric unit, as
described in 89 Ill. Adm. Code
148.25(c)(1).
2) Physical rehabilitation
services provided by:
A) A rehabilitation
hospital, as described in 89 Ill. Adm. Code
148.25(d)(2).
B) A distinct part rehabilitation unit, as
described in 89 Ill. Adm. Code
148.25(c)(2).
3) Services provided by a long
term acute care hospital, as described in 89 Ill. Adm. Code
148.25(d)(4),
that are not psychiatric services or services described in subsections (b)(6)
through (b)(7).
4) Inpatient
services, reimbursed pursuant to 89 Ill. Adm. Code
148.330.
5) Services provided by a large public
hospital, as described in 89 Ill. Adm. Code
148.25(a)(3).
6) Services provided by a large public
hospital, as described in 89 Ill. Adm. Code
148.25(a)(1) and
(2), through December 31, 2015.
7) Hospital residing long term care services,
as described in 89 Ill. Adm. Code
148.50(c).
8) Sub-acute alcoholism and substance abuse
treatment services, as defined in 77 Ill. Adm. Code
2090.40.
9) Inpatient services provided by Children's
Specialty Hospitals as described in 89 Ill. Adm. Code
148.116.
10) Non-transplant inpatient services
provided by non-cost reporting hospitals, which will be reimbursed at a rate
equal to the higher of $672.24 per day or the provider's per diem rate in
effect on June 30, 2014.
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