Section 148.310  Review Procedure

 

a)         Inpatient Rate Reviews

 

1)         Hospitals shall be notified of their inpatient rate for the rate year and shall have an opportunity to request a review of any rate for errors in calculation made by the Department.  Such a request must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its rates.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

2)         Hospitals reimbursed in accordance with Sections 148.250 through 148.300 and 89 Ill. Adm. Code 149 with respect to per diem add-ons for capital may request that an adjustment be made to their base year costs to reflect significant changes in costs that have been mandated in order to meet State, federal or local health and safety standards, and that have occurred since the hospital's filing of the base year cost report.  The allowable Medicare/Medicaid costs must be identified from the most recent audited cost report available.  These costs must be significant, i.e., on a per unit basis, they must constitute one percent or more of the total allowable Medicaid/Medicare unit costs for the same time period.  Appeals for base year cost adjustments must be submitted, in writing, to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its rates.  Such request shall include a clear explanation of the cost change and documentation of the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

b)         Disproportionate Share (DSH) and Medicaid Percentage Adjustment (MPA) Determination Reviews

 

1)         Hospitals shall be notified of their qualification for DSH and/or MPA payment adjustments and shall have an opportunity to request a review of the DSH and/or MPA add-on for errors in calculation made by the Department.  Such a request must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its disproportionate share and/or Medicaid Percentage Adjustment qualification and add-on calculations. Such request shall include a clear explanation of the error and documentation of the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

2)         DSH and/or MPA determination reviews shall be limited to the following:

 

A)        DSH and/or MPA Determination Criteria.  The criteria for DSH determination shall be in accordance with Section 148.120.  The criteria for MPA determination shall be in accordance with Section 148.122.  Review shall be limited to verification that the Department utilized criteria in accordance with State regulations.

 

B)        Medicaid Inpatient Utilization Rates.

 

i)          Medicaid inpatient utilization rates shall be calculated pursuant to Section 1923 of the Social Security Act and as defined in Section 148.120(k)(4).  Review shall be limited to verification that Medicaid inpatient utilization rates were calculated in accordance with federal and State regulations.

 

ii)         Hospitals' Medicaid inpatient utilization rates, as defined in Section 148.120(k)(4), which have been derived from unaudited cost reports or HDSC forms, are not subject to the Review Procedure with the exception of errors in calculation by the Department.  Pursuant to Section 148.120(c)(1)(B) and (c)(1)(C)(i) and (ii), hospitals shall have the opportunity to submit corrected information prior to the Department's final DSH and/or MPA determination.

 

C)        Low Income Utilization Rates.  Low Income utilization rates shall be calculated in accordance with Section 1923 of the Social Security Act, Section 148.120(a)(2) and (d), and Section 148.122(a)(2) and (c).  Review shall be limited to verification that low income utilization rates were calculated in accordance with federal and State regulations.

 

D)        Federally Designated Health Manpower Shortage Areas (HMSAs).  Illinois hospitals located in federally designated HMSAs shall be identified in accordance with 42 CFR 5 (1989) and Section 148.122(a)(3) based upon the methodologies utilized by, and the most current information available to, the Department from the federal Department of Health and Human Services as of June 30, 1992.   Review shall be limited to hospitals in locations that have failed to obtain designation as federally designated HMSAs only when such a request for review is accompanied by documentation from the Department of Health and Human Services substantiating that the hospital was located in a federally designated HMSA as of June 30, 1992.

 

E)         Excess Beds.  Excess bed information shall be determined in accordance with Public Act 86-268 (Section 148.122(a)(3) and 77 Ill. Adm. Code 1100) based upon the methodologies utilized by, and the most current information available to, the Illinois Health Facilities Planning Board as of July 1, 1991. Reviews shall be limited to requests accompanied by documentation from the Illinois Health Facilities Planning Board substantiating that the information supplied to and utilized by the Department was incorrect.

 

F)         Medicaid Obstetrical Inpatient Utilization Rates.  Medicaid obstetrical inpatient utilization rates shall be calculated in accordance with Section 148.122(a)(4), (h)(2), (h)(3) and (h)(4). Review shall be limited to verification that Medicaid obstetrical inpatient utilization rates were calculated in accordance with State regulations.

 

c)         Outlier Adjustment Reviews

The Department shall make outlier adjustments to payment amounts in accordance with 89 Ill. Adm. Code 149.105 or Section 148.130, whichever is applicable.  Hospitals shall be notified of the specific information that shall be utilized in the determination of those services qualified for an outlier adjustment and shall have an opportunity to request a review of such specific information for errors in calculation made by the Department.  Such a request must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of the specific information that shall be utilized in the determination of those services qualified for an outlier adjustment.  Such request shall include a clear explanation of the error and documentation of the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

d)         Cost Report Reviews

 

1)         Cost reports are required from:  

 

A)        All enrolled hospitals within the State of Illinois;

 

B)        All out-of-state hospitals providing 100 inpatient days of service per hospital fiscal year, to persons covered by the Illinois Medical Assistance Program; and

 

C)        All hospitals not located in Illinois that elect to be reimbursed under the methodology described in 89 Ill. Adm. Code 149 (the DRG PPS).

 

2)         The completed cost statement with a copy of the hospital's Medicare cost report and audited financial statement must be submitted annually within 90 days after the close of the hospital's fiscal year.  A one-time 30-day extension may be requested.  Such a request for an extension shall be in writing and shall be received by the Department's Office of Health Finance prior to the end of the 90-day filing period.  The Office of Health Finance shall audit the information shown on the Hospital Statement of Reimbursable Cost and Support Schedules.  The audit shall be made in accordance with generally accepted auditing standards and shall include tests of the accounting and statistical records and applicable auditing procedures.  Hospitals shall be notified of the results of the final audited cost report, which may contain adjustments and revisions that may have resulted from the audited Medicare Cost Report. Hospitals shall have the opportunity to request a review of the final audited cost report.  Such a request must be received in writing by the Department within 45 days after the date of the Department's notice to the hospital of the results of the finalized audit.  Such request shall include all items of documentation and analysis that support the request for review.  No additional data shall be accepted after the 45 day period.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

e)         Trauma Center Adjustment Reviews

 

1)         The Department shall make trauma care adjustments in accordance with Section 148.290(c).  Hospitals shall have the right to appeal the trauma center adjustment calculations if it is believed that a technical error has been made in the calculation by the Department.

 

2)         Trauma level designation is obtained from the Illinois Department of Public Health as of the first day of July preceding the trauma center adjustment rate period.  Review shall be limited to requests accompanied by documentation from the Illinois Department of Public Health, or the licensing agency in the state in which the hospital is located, substantiating that the information supplied to and utilized by the Department was incorrect.

 

3)         Appeals under this subsection (e) must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for trauma center adjustments and payment amounts.  Such a request shall include a clear explanation of the reason for the appeal and documentation of the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

f)          Medicaid High Volume Adjustment Reviews

The Department shall make Medicaid high volume adjustments in accordance with Section 148.290(d).  Review shall be limited to verification that the Medicaid inpatient days were calculated in accordance with Section 148.120. The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Medicaid high volume adjustments and payment amounts.  Such a request shall include a clear explanation of the reason for the appeal and documentation of the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

g)         Sole Community Hospital Designation Reviews

The Department shall make sole community hospital designations in accordance with 89 Ill. Adm. Code 149.125(b).  Hospitals shall have the right to appeal the designation if the hospital believes that a technical error has been made in the determination.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notification of the designation.  Such a request shall include a clear explanation of the reason for the appeal and documentation of the desired correction.  The Department shall notify the hospital of the results of the review no later than 30 days after receipt of the hospital's request for review.

 

h)         Geographic Designation Reviews

 

1)         The Department shall make rural hospital designations in accordance with Section 148.25(g)(3).  Hospitals shall have the right to appeal the designation if the hospital believes that a technical error has been made in the determination. The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notification of the designation.  Such a request shall include a clear explanation of the reason for the appeal and documentation of the desired correction.  The Department shall notify the hospital of the results of the review no later than 30 days after receipt of the hospital's request for review.

 

2)         The Department shall make urban hospital designations in accordance with Section 148.25(g)(4).  Hospitals shall have the right to appeal the designation if the hospital believes that a technical error has been made in the determination. The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notification of the designation.  Such a request shall include a clear explanation of the reason for the appeal and documentation of the desired correction.  The Department shall notify the hospital of the results of the review no later than 30 days after receipt of the hospital's request for review.

 

i)          Critical Hospital Adjustment Payment (CHAP) Reviews

 

1)         The Department shall make CHAP in accordance with Section 148.295. Hospitals shall be notified in writing of the results of the CHAP determination and calculation, and shall have the right to appeal the CHAP calculation or their ineligibility for the CHAP if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for CHAP and payment adjustment amounts, or a letter of notification that the hospital does not qualify for the CHAP.  Such a request shall include a clear explanation of the reason for the appeal and documentation of the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

2)         CHAP determination reviews shall be limited to the following:

 

A)        Federally Designated Health Professional Shortage Areas (HPSAs). Illinois hospitals located in federally designated HPSAs shall be identified in accordance with 42 CFR 5, and Section 148.295(a)(3)(B) and (b)(3) based upon the methodologies utilized by, and the most current information available to, the Department from the federal Department of Health and Human Services as of the last day of June preceding the CHAP rate period.  Review shall be limited to hospitals in locations that have failed to obtain designation as federally designated HPSAs only when such a request for review is accompanied by documentation from the Department of Health and Human Services substantiating that the hospital was located in a federally designated HPSA as of the last day of June preceding the CHAP rate period.

 

B)        Trauma level designation.  Trauma level designation is obtained from the Illinois Department of Public Health as of the last day of June preceding the CHAP rate period.  Review shall be limited to requests accompanied by documentation from the Illinois Department of Public Health, substantiating that the information supplied to and utilized by the Department was incorrect.

 

C)        Accreditation of Rehabilitation Facilities.  Accreditation of rehabilitation facilities shall be obtained from the Commission on Accreditation of Rehabilitation Facilities as of the last day of June preceding the CHAP rate period.  Review shall be limited to requests accompanied by documentation from the Commission, substantiating that the information supplied to and utilized by the Department was incorrect.

 

D)        Medicaid Inpatient Utilization Rates.  Medicaid inpatient utilization rates shall be calculated pursuant to Section 1923 of the Social Security Act and as defined in Section 148.120(k)(5).  Review shall be limited to verification that Medicaid inpatient utilization rates were calculated in accordance with federal and State regulations.

 

E)         Graduate Medical Education Programs.  Graduate Medical Education program information shall be obtained from the most recently published report of the American Accreditation Council for Graduate Medical Education, the American Osteopathic Association Division of Post-doctoral Training, or the American Dental Association Joint Commission on Dental Accreditation as of the last day of June preceding the CHAP rate period.  Review shall be limited to requests accompanied by documentation from the above, substantiating that the information supplied to and utilized by the Department was incorrect.

 

j)          Tertiary Care Adjustment Payment Reviews.  The Department shall make Tertiary Care Adjustment Payments in accordance with Section 148.296. Hospitals shall be notified in writing of the results of the Tertiary Care Adjustment Payments determination and calculation, and shall have the right to appeal the Tertiary Care Adjustment Payments calculation or their ineligibility for Tertiary Care Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Tertiary Care Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Tertiary Care Adjustment Payments. Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

k)         Pediatric Outpatient Adjustment Payment Reviews. The Department shall make Pediatric Outpatient Adjustment payments in accordance with Section 148.297. Hospitals shall be notified in writing of the results of the determination and calculation, and shall have the right to appeal the calculation or their ineligibility for payments under Section 148.297 if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification under Section 148.297 and payment adjustment amounts, or a letter of notification that the hospital does not qualify for such payments. Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

l)          Pediatric Inpatient Adjustment Payment Reviews. The Department shall make Pediatric Inpatient Adjustment payments in accordance with Section 148.298. Hospitals shall be notified in writing of the results of the determination and calculation, and shall have the right to appeal the calculation or their ineligibility for payments under Section 148.298 if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification under Section 148.298 and payment adjustment amounts, or a letter of notification that the hospital does not qualify for such payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

m)        Safety Net  Adjustment Payment Reviews.  The Department shall make Safety Net  Adjustment Payments in accordance with Section 148.126.  Hospitals shall be notified in writing of the results of the Safety Net Adjustment Payment determination and calculation, and shall have the right to appeal the Safety Net Adjustment Payment calculation or their ineligibility for Safety Net Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Safety Net Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Safety Net Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

n)         Psychiatric Adjustment Payment Reviews. The Department shall make Psychiatric Adjustment Payments in accordance with Section 148.105.   Hospitals shall be notified in writing of the results of the Psychiatric Adjustment Payments determination and calculation, and shall have a right to appeal the Psychiatric Adjustment Payments calculation or their ineligibility for Psychiatric Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Psychiatric Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Psychiatric Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

o)         Rural Adjustment Payment Reviews. The Department shall make Rural Adjustment Payments in accordance with Section 148.115.

 

1)         Hospitals shall be notified in writing of the results of the Rural Adjustment Payments determination and calculation, and shall have a right to appeal the Rural Adjustment Payments calculation or their ineligibility for Rural Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.

 

2)         The designation of Critical Access Provider or  Necessary Provider, which are qualifying criteria for Rural Adjustment Payments (see Section 148.115(a)), is obtained from the Illinois Department of Public Health (IDPH) as of the first day of July preceding the Rural Adjustment Payment rate period.  Review shall be limited to requests accompanied by documentation from IDPH, substantiating that the information supplied to and utilized by the Department was incorrect.

 

3)         The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Rural Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Rural Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

p)         Supplemental Tertiary Care Adjustment Payment Reviews.  The Department shall make Supplemental Tertiary Care Adjustment Payments in accordance with Section 148.85.  Hospitals shall be notified in writing of the results of the Supplemental Tertiary Care Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Supplemental Tertiary Care Adjustment Payments calculation or their ineligibility for Supplemental Tertiary Care Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Supplemental Tertiary Care Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Supplemental Tertiary Care Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

q)         Medicaid Inpatient Utilization Rate Adjustment Payment Reviews.  The Department shall make Medicaid Inpatient Utilization Rate Adjustment Payments in accordance with Section 148.90.  Hospitals shall be notified in writing of the results of the Medicaid Inpatient Utilization Rate Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Medicaid Inpatient Utilization Rate Adjustment Payments calculation or their ineligibility for Medicaid Inpatient Utilization Rate Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Medicaid Inpatient Utilization Rate Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Medicaid Inpatient Utilization Rate Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

r)          Medicaid Outpatient Utilization Rate Adjustment Payment Reviews.  The Department shall make Medicaid Outpatient Utilization Rate Adjustment Payments in accordance with Section 148.95.  Hospitals shall be notified in writing of the results of the Medicaid Outpatient Utilization Rate Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Medicaid Outpatient Utilization Rate Adjustment Payments calculation or their ineligibility for Medicaid Outpatient Utilization Rate Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Medicaid Outpatient Utilization Rate Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Medicaid Outpatient Utilization Rate Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

s)         Outpatient Rural Hospital Adjustment Payment Reviews.  The Department shall make Outpatient Rural Adjustment Payments in accordance with Section 148.100.  Hospitals shall be notified in writing of the results of the Outpatient Rural Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Outpatient Rural Adjustment Payments calculation or their ineligibility for Outpatient Rural Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Outpatient Rural Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Outpatient Rural Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

t)          Outpatient Service Adjustment Payment Reviews.  The Department shall make Outpatient Service Adjustment Payments in accordance with Section 148.103.  Hospitals shall be notified in writing of the results of the Outpatient Service Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Outpatient Service Adjustment Payments calculation or their ineligibility for Outpatient Service Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Outpatient Service Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Outpatient Service Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

u)         Psychiatric Base Rate Adjustment Payment Reviews.  The Department shall make Psychiatric Base Rate Adjustment Payments in accordance with Section 148.110.  Hospitals shall be notified in writing of the results of the Psychiatric Base Rate Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Psychiatric Base Rate Adjustment Payments calculation or their ineligibility for Psychiatric Base Rate Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Psychiatric Base Rate Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Psychiatric Base Rate Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

v)         High Volume Adjustment Payment Reviews. The Department shall make High Volume Adjustment Payments in accordance with Section 148.112. Hospitals shall be notified in writing of the results of the High Volume Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the High Volume Adjustment Payments calculation or their ineligibility for High Volume Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department. The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for High Volume Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for High Volume Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

w)        Medicaid Eligibility Payment Reviews.  The Department shall make Medicaid Eligibility Payments in accordance with Section 148.402.  Hospitals shall be notified in writing of the results of the Medicaid Eligibility Payments determination and calculation.  Hospitals shall have a right to appeal the Medicaid Eligibility Payments calculation or their ineligibility for Medicaid Eligibility Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Medicaid Eligibility Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Medicaid Eligibility Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

x)         Medicaid High Volume Adjustment Payment Reviews.  The Department shall make Medicaid High Volume Payments in accordance with Section 148.404.  Hospitals shall be notified in writing of the results of the Medicaid High Volume Payments determination and calculation.  Hospitals shall have a right to appeal the Medicaid High Volume Payments calculation or their ineligibility for Medicaid High Volume Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Medicaid High Volume Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Medicaid High Volume Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

y)         Intensive Care Adjustment Payment Reviews.  The Department shall make Intensive Care Payments in accordance with Section 148.406.  Hospitals shall be notified in writing of the results of the Intensive Care Payments determination and calculation.  Hospitals shall have a right to appeal the Intensive Care Payments calculation or their ineligibility for Intensive Care Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Intensive Care Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Intensive Care Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

z)         Trauma Center Adjustment Payment Reviews.  The Department shall make Trauma Center Adjustment Payments in accordance with Section 148.408.  Hospitals shall be notified in writing of the results of the Trauma Center Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Trauma Center Adjustment Payments calculation or their ineligibility for Trauma Center Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Trauma Center Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Trauma Center Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

aa)       Psychiatric Rate Adjustment Payment Reviews.  The Department shall make Psychiatric Rate Adjustment Payments in accordance with Section 148.410.  Hospitals shall be notified in writing of the results of the Psychiatric Rate Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Psychiatric Rate Adjustment Payments calculation or their ineligibility for Psychiatric Rate Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Psychiatric Rate Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Psychiatric Rate Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

bb)       Rehabilitation Adjustment Payment Reviews.  The Department shall make Rehabilitation Adjustment Payments in accordance with Section 148.412.  Hospitals shall be notified in writing of the results of the Rehabilitation Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Rehabilitation Adjustment Payments calculation or their ineligibility for Rehabilitation Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Rehabilitation Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Rehabilitation Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

cc)       Supplemental Tertiary Care Adjustment Payment Reviews.  The Department shall make Supplemental Tertiary Care Adjustment Payments in accordance with Section 148.414.  Hospitals shall be notified in writing of the results of the Supplemental Tertiary Care Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Supplemental Tertiary Care Adjustment Payments calculation or their ineligibility for Supplemental Tertiary Care Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Supplemental Tertiary Care Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Supplemental Tertiary Care Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

dd)       Crossover Percentage Adjustment Payment Reviews.  The Department shall make Crossover Percentage Adjustment Payments in accordance with Section 148.416.  Hospitals shall be notified in writing of the results of the Crossover Percentage Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Crossover Percentage Adjustment Payments calculation or their ineligibility for Crossover Percentage Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Crossover Percentage Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Crossover Percentage Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

ee)       Long Term Acute Care Hospital Adjustment Payment Reviews.  The Department shall make Long Term Acute Care Hospital Adjustment Payments in accordance with Section 148.418.  Hospitals shall be notified in writing of the results of the Long Term Acute Care Hospital Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Long Term Acute Care Hospital Adjustment Payments calculation or their ineligibility for Long Term Acute Care Hospital Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Long Term Acute Care Hospital Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Long Term Acute Care Hospital Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

ff)         Obstetrical Care Adjustment Payment Reviews.  The Department shall make Obstetrical Care Adjustment Payments in accordance with Section 148.420. Hospitals shall be notified in writing of the results of the Obstetrical Care Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Obstetrical Care Adjustment Payments calculation or their ineligibility for Obstetrical Care Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Obstetrical Care Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Obstetrical Care Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

gg)       Outpatient Access Payment Reviews.  The Department shall make Outpatient Access Payments in accordance with Section 148.422.  Hospitals shall be notified in writing of the results of the Outpatient Access Payments determination and calculation.  Hospitals shall have a right to appeal the Outpatient Access Payments calculation or their ineligibility for Outpatient Access Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Outpatient Access Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Outpatient Access Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

hh)       Outpatient Utilization Payment Reviews.  The Department shall make Outpatient Utilization Payments in accordance with Section 148.424.  Hospitals shall be notified in writing of the results of the Outpatient Utilization Payments determination and calculation.  Hospitals shall have a right to appeal the Outpatient Utilization Payments calculation or their ineligibility for Outpatient Utilization Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Outpatient Utilization Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Outpatient Utilization Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

ii)         Outpatient Complexity of Care Adjustment Payment Reviews.  The Department  shall make Outpatient Complexity of Care Adjustment Payments in accordance with Section 148.426.  Hospitals shall be notified in writing of the results of the Outpatient Complexity of Care Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Outpatient Complexity of Care Adjustment Payments calculation or their ineligibility for Outpatient Complexity of Care Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Outpatient Complexity of Care Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Outpatient Complexity of Care Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

jj)         Rehabilitation Hospital Adjustment Payment Reviews.  The Department shall make Rehabilitation Hospital Adjustment Payments in accordance with Section 148.428.  Hospitals shall be notified in writing of the results of the Rehabilitation Hospital Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Rehabilitation Hospital Adjustment Payments calculation or their ineligibility for Rehabilitation Hospital Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Rehabilitation Hospital Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Rehabilitation Hospital Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

kk)       Perinatal Outpatient Adjustment Payment Reviews.  The Department shall make Perinatal Outpatient Adjustment Payments in accordance with Section 148.430.  Hospitals shall be notified in writing of the results of the Perinatal Outpatient Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Perinatal Outpatient Adjustment Payments calculation or their ineligibility for Perinatal Outpatient Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Perinatal Outpatient Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Perinatal Outpatient Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

ll)         Supplemental Psychiatric Adjustment Payment Reviews.  The Department shall make Supplemental Psychiatric Adjustment Payments in accordance with Section 148.432. Hospitals shall be notified in writing of the results of the Supplemental Psychiatric Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Supplemental Psychiatric Adjustment Payments calculation or their ineligibility for Supplemental Psychiatric Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Supplemental Psychiatric Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Supplemental Psychiatric Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

mm)     Outpatient Community Access Adjustment Payment Reviews.  The Department shall make Outpatient Community Access Adjustment Payments in accordance with Section 148.434.  Hospitals shall be notified in writing of the results of the Outpatient Community Access Adjustment Payments determination and calculation.  Hospitals shall have a right to appeal the Outpatient Community Access Adjustment Payments calculation or their ineligibility for Outpatient Community Access Adjustment Payments if the hospital believes that a technical error has been made in the calculation by the Department.  The appeal must be submitted in writing to the Department and must be received or post marked within 30 days after the date of the Department's notice to the hospital of its qualification for Outpatient Community Access Adjustment Payments and payment adjustment amounts, or a letter of notification that the hospital does not qualify for Outpatient Community Access Adjustment Payments.  Such a request must include a clear explanation of the reason for the appeal and documentation that supports the desired correction.  The Department shall notify the hospital of the results of the review within 30 days after receipt of the hospital's request for review.

 

nn)       For purposes of this Section, the term "post marked" means the date of processing by the United States Post Office or any independent carrier service.

 

oo)       The review procedures provided for in this Section may not be used to submit any new or corrected information that was required to be submitted by a specific date in order to qualify for a payment or payment adjustment.  In addition, only information that was submitted expressly for the purpose of qualifying for the payment or payment adjustment under review shall be considered by the Department.  Information that has been submitted to the Department for other purposes will not be considered during the review process.

 

(Source:  Amended at 30 Ill. Reg. 383, effective December 28, 2005)