TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 148 HOSPITAL SERVICES
SECTION 148.410 PSYCHIATRIC RATE ADJUSTMENT PAYMENTS

 

Section 148.410  Psychiatric Rate Adjustment Payments

 

a)         Qualifying Criteria.  Psychiatric Rate Adjustment Payments described in subsection (b) of this Section shall be made to an Illinois psychiatric hospital and an Illinois general acute care hospital that has a distinct part psychiatric unit, excluding the following hospitals:

 

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).

 

b)         Psychiatric Rate Adjustment Payments

 

1)         For a hospital qualifying under subsection (a) of this Section, the Department shall pay an amount equal to $420 less the hospital's per diem rate for Medicaid inpatient psychiatric services, in effect on July 1, 2002, multiplied by the number of Medicaid inpatient psychiatric days provided in the psychiatric rate base period.  In no event, however, shall that amount be less than zero.

 

2)         For a hospital qualifying under subsection (a) of this Section whose inpatient psychiatric per diem rate is greater than $420, the Department shall pay an amount equal to $40 multiplied by the number of Medicaid inpatient psychiatric days provided in the psychiatric rate base period.

 

3)         For an Illinois psychiatric hospital located in a county with a population in excess of three million people that did not qualify for Medicaid Percentage Adjustments, as described in Section 148.122, for the 12-month period beginning on October 1, 2004, the Department shall pay an amount equal to $150 multiplied by the number of Medicaid inpatient psychiatric days provided in the psychiatric rate base period.

 

4)         For an Illinois psychiatric hospital located in a county with a population in excess of three million people, but outside of a city with a population in excess of one million people, and did qualify for Medicaid Percentage Adjustments, as described in Section 148.122, for the 12-month period beginning on October 1, 2004, the Department shall pay an amount equal to $20 multiplied by the number of Medicaid inpatient psychiatric days provided in the psychiatric rate base period.

 

c)         Payment to a Qualifying Hospital

 

1)         For the psychiatric rate adjustment period for fiscal year 2006, fiscal year 2007 and fiscal year 2008 total payments will equal the methodologies described in subsection (b) 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 (e) of this Section being met shall be paid within 100 days after the conditions described in subsection (e) of this Section 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.

 

d)         Definitions

 

1)         "Medicaid inpatient psychiatric days" means, for a given hospital, the sum of days of inpatient psychiatric 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 that Act (Medicaid/Medicare crossover days), as tabulated from the Department's paid claims data for admissions occurring in the psychiatric base period that were adjudicated by the Department through June 30, 2004.

 

2)         "Psychiatric rate 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.

 

3)         "Psychiatric rate base period" means the 12-month period beginning on July 1, 2002 and ending on June 30, 2003.

 

e)         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)