CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 148 HOSPITAL SERVICES
SECTION 148.406 INTENSIVE CARE ADJUSTMENT PAYMENTS
Section 148.406 Intensive Care Adjustment Payments
a) Qualifying Criteria. Intensive Care Adjustment Payments shall be made to qualifying Illinois general acute care hospitals as described in Section 148.270(c)(1). A hospital not otherwise excluded under subsection (b) of this Section shall qualify for payment if the hospital is located in a large urban area and has a ratio of Medicaid intensive care days to total Medicaid days greater than 19 percent for the intensive care adjustment period.
b) The following classes of hospitals are ineligible for Intensive Care Adjustment Payments associated with the qualifying criteria listed in subsection (a) of this Section:
1) County-owned hospitals as described in Section 148.25(b)(1)(A).
2) Hospitals organized under the University of Illinois Hospital Act, as described in Section 148.25(b)(1)(B).
3) A hospital owned or operated by a State agency, as described in Section 148.25(b)(6).
c) Intensive Care Adjustment Payments
1) Each qualifying hospital with an intensive care ratio of less than 30 percent, shall receive payment equal to the product of:
A) The ratio of Medicaid intensive care days to total Medicaid days;
B) Multiplied by total Medicaid days;
C) Multiplied by $1,000.
2) Each qualifying hospital with an intensive care ratio percentage equal to or greater than 30 percent shall receive payment equal to the product of:
A) The ratio of Medicaid intensive care days to total Medicaid days;
B) Multiplied by total Medicaid days;
C) Multiplied by $2,800.
3) A hospital that enrolled to provide Medicaid services during State fiscal year 2003 shall have its utilization and associated reimbursements annualized prior to the payment calculations being performed under this subsection (c).
d) Payment to a Qualifying Hospital
1) For the intensive care adjustment period for fiscal year 2006, fiscal year 2007 and fiscal year 2008 total payments will equal the methodologies described in subsection (c) of this Section and shall be paid to the hospital in four equal installments on or before the seventh State business day of September, December, March, and May. The sum of the amounts required prior to the conditions described in subsection (f) of this Section being met shall be paid within 100 days after the conditions described in subsection (f) have been met.
2) If a hospital closes during the fiscal year, payments will be prorated based on the number of days the hospital was open during the fiscal year.
e) Definitions
1) "Intensive care adjustment period" means, beginning August 1, 2005, the 11-month period beginning on August 1, 2005 and ending June 30, 2006, and beginning July 1, 2006, the 12-month period beginning July 1 of the year and ending June 30 of the following year.
2) "Intensive care base period" means the cost report on file with the Department on July 1, 2004, for the hospital's fiscal year ending in 2002.
3) "Large urban area" means an area located within a metropolitan statistical area, as defined by the U.S. Office of Management and Budget, 725 17th Street N.W., Washington D.C. 20503, in OMB Bulletin 04-03, dated February 18, 2004, with a population in excess of 1,000,000, and with an urban hospital as described in Section 148.25(g)(4).
4) "Medicaid intensive care days" means, for a given hospital, the sum of days of inpatient hospital service for intensive care days provided to recipients of medical assistance under Title XIX of the federal Social Security Act, excluding days for individuals eligible for Medicare under Title XVIII of the Act (Medicaid/Medicare crossover days), as contained in the hospital's cost report on file with the Department as of July 1, 2004, for the hospital's fiscal year ending in 2002.
5) "Total Medicaid inpatient days" means, for a given hospital, the sum of days of inpatient hospital service provided to recipients of medical assistance under Title XIX of the federal Social Security Act, excluding days for individuals eligible for Medicare under Title XVIII of the Act (Medicaid/Medicare crossover days), as contained in the hospital's cost report on file with the Department as of July 1, 2004, for the hospital's fiscal year ending in 2002.
f) Payment Limitations: Payments under this Section are not due and payable until:
1) the methodologies described in this Section receive federal approval from the Centers for Medicare and Medicaid Services in an appropriate State Plan Amendment;
2) the assessment imposed under 89 Ill. Adm. Code 140.80 is determined to be a permissible tax under Title XIX of the Social Security Act; and
3) the assessment described in 89 Ill. Adm. Code 140.80 is in effect.
(Source: Added at 30 Ill. Reg. 383, effective December 28, 2005)