Provider Notice Issued 06/29/2018

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.

A new link for Hospital Rate Sheets Effective July 1, 2018 has been posted on the Hospital Reimbursement Notifications webpage. Hospitals can access their updated rate sheet by clicking on the appropriate link at that site. 
 
Hospital assessment changes will be released in a separate notification.
 
Questions regarding this notice may be directed to the Bureau of Rate Development and Analysis at 217-785-0710.
 
 
Teresa T. Hursey
Interim Director  

Notices

 

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