Section 148.428  Rehabilitation Hospital Adjustment Payments

a)         Qualifying Criteria.  Rehabilitation Hospital Adjustment Payments, as described in subsection (c) of this Section, shall be made to a qualifying Illinois freestanding rehabilitation hospital that did not qualify for Medicaid Percentage Adjustment Payments as described in Section 148.122 for the 12-month period beginning on October 1, 2004, if not otherwise excluded under subsection (b) of this Section.

b)         The following classes of hospitals are ineligible for Rehabilitation Hospital 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 89 Ill. Adm. Code 148.25(b)(6).

c)         Rehabilitation Hospital Adjustment Payments for hospitals qualifying under subsection (a) of this Section will receive an amount equal to three multiplied by the hospital's outpatient ambulatory procedure listing payments for Group 6A services provided during the rehabilitation hospital base period.

d)         Payment to a Qualifying Hospital

1)         For the rehabilitation hospital 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)         "Outpatient ambulatory procedure listing payments for Group 6A services" means, for a given hospital, the sum of payments for ambulatory procedure listing services as described in Section 148.140(b)(1)(F), excluding payments for individuals eligible for Medicare under Title XVIII of the Act (Medicaid/Medicare crossover days), as tabulated from the Department's paid claims data for admissions occurring in the rehabilitation hospital base period that were adjudicated by the Department through June 30, 2004.

2)         "Rehabilitation 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.

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

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)