Sec. 35. LTAC supplemental per diem rate.

487 words·~2 min read·/il/chapter-210/act-155/35

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(a)The Department must pay an LTAC supplemental per diem rate calculated under this Section to LTAC hospitals that meet the requirements of Section 15 of this Act for patients:

(1)who upon admission to the LTAC hospital meet LTAC hospital criteria; and

(2)whose care is primarily paid for by the Department under Title XIX of the Social

Security Act or whose care is primarily paid for by the Department after the patient has exhausted his or her benefits under Medicare.

(b)The Department must not pay the LTAC supplemental per diem rate calculated under this Section if any of the following conditions are met:

(1)the LTAC hospital no longer meets the requirements under Section 15 of this Act or

terminates the agreement specified under Section 15 of this Act;

(2)the patient does not meet the LTAC hospital criteria upon admission; or

(3)the patient's care is primarily paid for by Medicare and the patient has not

exhausted his or her Medicare benefits, resulting in the Department becoming the primary payer.

(c)The Department may adjust the LTAC supplemental per diem rate calculated under this Section based only on the conditions and requirements described under Section 40 and Section 45 of this Act.

(d)The LTAC supplemental per diem rate shall be calculated using the LTAC hospital's inflated cost per diem, defined in subsection

(f)of this Section, and subtracting the following:

(1)The LTAC hospital's Medicaid per diem inpatient rate as calculated under 89 Ill.

Adm. Code 148.270(c)(4).

(2)The LTAC hospital's disproportionate share

(DSH)rate as calculated under 89 Ill.

Adm. Code 148.120.

(3)The LTAC hospital's Medicaid Percentage Adjustment

(MPA)rate as calculated under 89

Ill. Adm. Code 148.122.

(4)The LTAC hospital's Medicaid High Volume Adjustment

(MHVA)rate as calculated under

89 Ill. Adm. Code 148.290(d).

(e)LTAC supplemental per diem rates effective July 1, 2012 shall be the amount in effect as of October 1, 2010. No new hospital may qualify for the program after the effective date of this amendatory Act of the 97th General Assembly.

(f)For the purposes of this Section, "inflated cost per diem" means the quotient resulting from dividing the hospital's inpatient Medicaid costs by the hospital's Medicaid inpatient days and inflating it to the most current period using methodologies consistent with the calculation of the rates described in paragraphs (2), (3), and

(4)of subsection (d). The data is obtained from the LTAC hospital's most recent cost report submitted to the Department as mandated under 89 Ill. Adm. Code 148.210.

(g)On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Act or the Illinois Public Aid Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e of the Illinois Public Aid Code.