Date: June 29, 2018
To: Participating Hospitals: Chief Executives, Chief Financial Officers, and Patient Accounts Managers; and Ambulatory Surgical Treatment Centers
Re: Changes to Hospital Inpatient and Outpatient Reimbursement Systems Effective with Dates of Service on and after July 1, 2018
Pursuant to Public Act 100-0580 and Public Act 100-0581, the Illinois Department of Healthcare and Family Services is changing the methods and standards by which the Department will reimburse providers. These changes are applicable to fee-for-service payments and are effective for inpatient discharges and outpatient dates of service on and after July 1, 2018. These reimbursement changes do not affect any claim completion instructions.
Hospital inpatient reimbursement under the Illinois Medical Assistance program will be increased as follows:
· The following APR-DRG’s will be added to those eligible for the Trauma Services policy adjustor:
o 841 Extensive three degree burns with skin graft, as of July 1, 2018.
o 842 Full thickness burns with graft, as of July 1, 2018.
o 843 Extensive burns without skin graft, as of July 1, 2018.
o 844 Partial thickness burns with or without graft, as of July 1, 2018.
· Perinatal Level II and II+ hospitals will be included in the eligibility for the Perinatal Services policy adjustor.
· Hospital inpatient base rates will be increased.
Hospital outpatient reimbursement under the Illinois Medical Assistance program will be increased as follows:
· Add-on payments will be made for the following expensive drugs and devices:
o Expensive devices billed with revenue codes 0274-0276 or 0278 and assigned EAPG code of 490, or 1001-1020.
o Expensive drugs assigned EAPG codes 430-441, 443, 444, 460-465, 495, 496, or 1090.
· The High Outpatient Volume Hospital adjustment factor will be increased.
· Small public hospitals will be eligible for the High Outpatient Volume Hospital adjustment factor.
· Hospital outpatient base rates will be increased.
The Department will initiate a 30-day hold on inpatient and outpatient claims while implementing the necessary reimbursement system changes. The hold will affect only those inpatient claims with a discharge date on and after July 1, 2018, and outpatient claims with a date of service on and after July 1, 2018.