Provider Notice Issued 04/02/2021

Date:     April 2, 2021

 

To:       Participating Hospitals:  Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers

 

Re:      Hospital Long Term Care Days Reimbursement

 

 

This notice informs hospitals of a payment mechanism when continued hospital level of care is no longer necessary and discharge of the patient is delayed due to the lack of available placement outside of the hospital at the next level of care. This applies only to inpatient claims for services paid under the Department’s fee-for-service program and is not applicable to services provided to patients covered by a HealthChoice Illinois managed care plan.

 

Pursuant to 89 Ill. Admin. Code Section 148.50, the Department will consider reimbursement for days that are not covered by the hospital inpatient stay but where discharge is not allowable due to the inability to place the patient in a lower level of care. These days are identified in the rule as hospital long term care days.

 

Process for Requesting Hospital Long Term Care Days


            · A hospital must make five attempts to place the patient in a lower level of care prior to contacting the Department to apply for hospital long term care days reimbursement. If the attempts are unsuccessful, hospitals must complete Form HFS 1329 and submit it via email to hfs.Hospitals@illinois.gov. Hospitals are reminded that the completed form contains protected health information and HIPAA privacy guidelines should be followed when emailing the form. Please note, only days that occur on and after the date of form submittal will be considered for reimbursement. For general acute care stays that are reimbursed under the DRG system, only days that exceed the average length of stay for that DRG will be considered for reimbursement. 

 

             ·  An admission through discharge DRG-reimbursed claim or the final claim of a per diem reimbursed stay, both of which must identify the non-covered hospital long term care days, should be submitted to the Department via the usual process. Department staff will monitor the claim adjudication and when the claim is in paid status, will review Form HFS 1329 and calculate the number of eligible hospital long term care days. Each approved hospital long term care day will be reimbursed at $289.48.

 

             · The Department will generate an adjustment for the hospital long term care days payment. An Adjustment Reason Code in the sequence of 8548 through 8555 with description “Reimburse Hosp LTC Days” will be identified on the Remittance Advice.


Hospitals may submit Form HFS 1329 for claims with dates of admission beginning July 1, 2019. For claims where the date of admission is prior to April 1, 2021, hospital long term care days will be reimbursed for all claims where a form is received noting the five attempted placements, a claim is on file with the Department with non-covered days reported, and for acute care claims reimbursed under the DRG system, the administrative days exceed the average length of stay. For the admission period above, the payment limitation to only days on or after notification is received by the Department is not applicable. 

 

Questions may be directed to a hospital billing consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

 

 

Kelly Cunningham, Administrator

Division of Medical Programs

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