Section 148.116  Reimbursement Methodologies for Children's Specialty Hospitals

Effective for dates of outpatient services on or after July 1, 2014 and inpatient discharges on or after July 1, 2014:

a)         Inpatient general acute care services provided by a children's specialty hospital located in Illinois, as defined in Section 148.25(i) and excluded from the DRG PPS pursuant to 89 Ill. Adm. Code 149.50(b), shall, per day of covered inpatient care, be reimbursed as follows:

1)         For a hospital that would not have met the definition of a children's specialty hospital as of July 1, 2013, $1,400.00 per day.

2)         For a hospital that would have met the definition of a children's specialty hospital as of July 1, 2013, a rate equal to the per diem base rate in place on July 1, 2013, multiplied by a factor of 1.37.

3)         The total payment for inpatient stay will equal the sum of:

A)        The payment determined in this subsection; and

B)        Any applicable adjustments to payment specified in Section 148.290.

b)         Effective for dates of service on and after July 1, 2018, rates in subsection (a) are increased by 10.5 percent.

c)         For children's specialty hospitals defined in 148.25(i), outpatient and clinic services shall be reimbursed in accordance with Section 148.140.

d)         For cost reporting hospitals located outside of Illinois that meet the definition of a children's specialty hospital as defined in Section 148.25(i) as of 6/30/14, for inpatient general acute care and rehabilitation services, the hospital shall have a per diem amount equal to the rate in place with the Department as of June 30, 2014.  The total payment for inpatient stay will equal the sum of the payment determined in this Subsection and any applicable adjustments to payments specified in Section 148.290.

(Source:  Amended at 44 Ill. Reg. 19767, effective December 11, 2020)