Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 148 - HOSPITAL SERVICES › Subpart B - REIMBURSEMENT AND RELATED PROVISIONS › Section 148.310 - Review Procedure

Current through Register Vol. 48, No. 28, July 12, 2024
Effective for dates of service on or after July 1,
				  2014:
a) Rate Reviews
Hospitals shall be notified of their rates for the rate year
				  and shall have an opportunity to request a review, pursuant to subsection (f),
				  of any rate for errors in calculation made by the Department.
b) Disproportionate Share Hospital (DSH) and
				Medicaid Percentage Adjustment (MPA) Determination Reviews
1) Hospitals shall be notified of their
				qualification for DSH or MPApayment adjustments and shall have an opportunity
				to request a review pursuant to subsection (f) of the DSH or MPA add-on for
				errors in calculation made by the Department.
2) DSH or MPA determination reviews shall be
				limited to the following:
A) DSH or MPA
				Determination Criteria. The criteria for DSH determination shall be in
				accordance with Section
				148.120.
				The criteria for MPA determination shall be in accordance with Section
				148.122.
				Review shall be limited to verification that the Department utilized criteria
				in accordance with State regulations.
B) Medicaid Inpatient Utilization Rates.
i) Medicaid inpatient utilization rates shall
				be calculated pursuant to Section 1923 of the Social Security Act and as
				defined in Section
				148.120(i)(4).
				Review shall be limited to verification that Medicaid inpatient utilization
				rates were calculated in accordance with federal and State
				regulations.
ii) Hospitals'
				Medicaid inpatient utilization rates, as defined in Section
				148.120(i)(4),
				which have been derived from unaudited cost reports, are not subject to the
				Review Procedure with the exception of errors in calculation by the Department.
				Pursuant to Section
				148.120(c)(1)(B),
				hospitals shall have the opportunity to submit corrected information prior to
				the Department's final DSH or MPA determination.
C) Low Income Utilization Rates. Low Income
				utilization rates shall be calculated in accordance with Section 1923 of the
				Social Security Act, as defined in Section
				148.120(a)(2).
				Review shall be limited to verification that low income utilization rates were
				calculated in accordance with federal and State regulations.
D) Federally Designated Health Manpower
				Shortage Areas (HMSAs). Illinois hospitals located in federally designated
				HMSAs shall be identified in accordance with 42 CFR 5(1989) and Section
				148.122(a)(3)
				based upon the methodologies utilized by, and the most current information
				available to, the Department from the federal Department of Health and Human
				Services. Review shall be limited to hospitals in locations that have failed to
				obtain designation as federally designated HMSAs only when such a request for
				review is accompanied by documentation from the Department of Health and Human
				Services substantiating that the hospital was located in a federally designated
				HMSA.
E) Excess Beds. Excess bed
				information shall be determined in accordance with Public Act 86-268 (Section
				148.122(a)(3)
				 and 77 Ill. Adm. Code 1100) based upon the
				methodologies utilized by, and the most current information available to, the
				Illinois Health Facilities Planning Board as of July 1, 1991. Reviews shall be
				limited to requests accompanied by documentation from the Illinois Health
				Facilities Planning Board substantiating that the information supplied to and
				utilized by the Department was incorrect.
F) Medicaid Obstetrical Inpatient Utilization
				Rates. Medicaid obstetrical inpatient utilization rates shall be calculated in
				accordance with Section
				148.122(g)(3).
				Review shall be limited to verification that Medicaid obstetrical inpatient
				utilization rates were calculated in accordance with State
				regulations.