Section 148.418  Long Term Acute Care Hospital Adjustment Payments

a)         Qualifying Criteria.  Long Term Acute Care Hospital Adjustment Payments described in subsection (b) of this Section shall be made to an Illinois long term stay hospital, as defined in 89 Ill. Adm. Code 149.50(c)(4), excluding:

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)         Long Term Acute Care Hospital Adjustment Payments

1)         For a hospital qualifying under subsection (a) of this Section, the Department shall pay an amount equal to the product of $125 multiplied by Medicaid inpatient days provided during the long term acute care hospital base period.

2)         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 (b).

c)         Payment to a Qualifying Hospital

1)         For the long term acute care hospital 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) 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)         "Long term acute care hospital 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)         "Long term acute care hospital base period" means the 12-month period beginning on July 1, 2002 and ending on June 30, 2003.

3)         "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 that Act (Medicaid/Medicare crossover days), as tabulated from the Department's paid claims data for admissions occurring in the long term care hospital base period that was adjudicated by the Department through June 30, 2004.

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:  Amended at 31 Ill. Reg. 8123, effective May 30, 2007)