ILLINOIS REGISTER 5695
09
DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
NOTICE OF PROPOSED AMENDMENT
1) For admissions occurring within the rate period described in Section
148.25(g)(2)(A):
A) In the case of a distinct part unit, as described in 89 Ill. Adm. Code
149.50(d), the Department shall divide the hospital's Medicaid
charges per diem (identified on adjudicated claims submitted by
the provider during the most recently completed fiscal year for
which complete data are available) related to the distinct part unit
by the hospital's total charge per diem for all claims for the same
time period.
B) The resulting quotient, as calculated in subsection (b)(1)(A), shall
be multiplied by the hospital's total operating cost per diem, as
calculated in Section 148.260(a)(1)(B).
C) The capital related cost per diem, as calculated in Section
148.260(a)(2), is then added to the resulting product calculated in
subsection (b)(1)(B), subject to the inflation adjustment described
in Section 148.260(c)(1).
D) Subject to the provisions of subsections (b)(1)(E) and (b)(1)(F), the
final distinct part unit payment rate shall be the lower of:
i) The result of the calculations described in subsections
(b)(1)(A) through (b)(1)(B); or
ii) The hospital's alternate cost per diem rate, as calculated in
subsection (a) of this Section.
E) In no case shall the hospital's final distinct part unit payment rate
be greater than three standard deviations above the mean distinct
part unit payment rate.
F) In the case of a new distinct part unit for which the Department has
insufficient adjudicated claims history data available, the
Department shall utilize the average payment rate calculated under
this subsection (b)(1) for like distinct part units.
2) For admissions occurring within a rate period described in Section
