TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 148 HOSPITAL SERVICES
SECTION 148.460 CATASTROPHIC RELIEF PAYMENTS

 

Section 148.460  Catastrophic Relief Payments

 

a)         Qualifying Criteria.  Catastrophic Relief Payments, as described in this subsection (a), shall be made to Illinois hospitals, except publicly owned or operated hospitals or a hospital identified under 89 Ill. Adm. Code 149.50(c)(3)(B), that have an MIUR greater than the current statewide mean, are not a publicly owned hospital, and are not part of a multiple hospital network, unless the hospital has an MIUR greater than the current statewide mean plus two standard deviations.  Payments to qualifying hospitals will be based on the criteria described in this Section.

 

b)         Payments 

 

1)         An Illinois hospital qualifying under subsection (a) of this Section that is a general acute care hospital with greater than 3,000 Medicaid admissions and a case mix greater than 70% will receive the greater of:

 

A)        Medicaid admissions multiplied by $2,250; or

 

B)        $8,000,000.

 

2)         An Illinois hospital qualifying under subsection (a) of this Section that received payments under Section 148.456 will receive the greater of:

 

A)        2% of the annual Outpatient Ambulatory Procedure Listing Increase Payments, as defined in Section 148.456; or

 

B)        $175,000.

 

3)         With the exception of psychiatric hospitals, a hospital qualifying under subsection (a) of this Section will receive the following:

 

A)        $1,750,000 for Illinois hospitals with more than 50 Title XXI admissions in the Catastrophic Relief Payments base period.

 

B)        $1,600,000 for Illinois hospitals with 20 to 50 Title XXI admissions in the Catastrophic Relief Payments base period.

 

C)        $750,000 for Illinois hospitals with up to 20 Title XXI admissions in the Catastrophic Relief Payments base period.

 

4)         A psychiatric hospital qualifying under subsection (a) of this Section will receive the following:

 

A)        $1,312,500 for an Illinois hospital with more than 50 Title XXI admissions in the Catastrophic Relief Payments base period.

 

B)        $1,200,000 for an Illinois hospital with 20 to 50 Title XXI admissions in the Catastrophic Relief Payments base period.

 

C)        $562,500 for an Illinois hospital with up to 20 Title XXI admissions in the Catastrophic Relief Payments base period.

 

5)         Payments under this Section are effective for State fiscal year 2009.  Payments are not effective for dates of service on or after July 1, 2009.

 

c)         Definitions

 

1)         "MIUR", for a given hospital, has the meaning ascribed in Section 148.120(i)(4) and shall be determined in accordance with Section 148.120(c) and (f). For purposes of this Section, the MIUR determination that was used to determine a hospital's eligibility for Disproportionate Share Hospital Adjustment payments in rate year 2009 shall be the same determination used to determine a hospital's eligibility for Catastrophic Relief Payments in the Adjustment Period.

 

2)         "General acute care hospital" is a hospital that does not meet the definition of a hospital ascribed in 89 Ill. Adm. Code 149.50(c).

 

3)         "Title XXI admissions" means recipients of medical assistance through the Illinois State Child Health Plan under Title XXI of the Social Security Act.

 

4)         "Catastrophic Relief Payments base period" means the 12-month period beginning on July 1, 2006 and ending June 30, 2007.

 

5)         "Psychiatric hospital" is a hospital as defined in 89 Ill. Adm. Code 149.50(c)(1).

 

6)         "Case mix index" means, for a given hospital, the quotient resulting from dividing the sum of all the diagnosis related grouping relative weighting factors in effect on January 1, 2005, for all category of service 20 admissions for State fiscal year 2005, excluding Medicare crossover admissions and transplant admissions reimbursed under Section 148.82, by the total number of category of service 20 admissions for State fiscal year 2005, excluding Medicare crossover admissions and transplant admissions reimbursed under Section 148.82.

 

7)         "Medicaid admissions" means State fiscal year 2007 hospital inpatient admissions that were subsequently adjudicated by the Department through the last day of June preceding the 2009 CHAP (Section 148.295) rate period and contained within the Department's paid claims database, for recipients of medical assistance under Title XIX of the Social Security Act, excluding Medicare/Medicaid crossover admissions.

 

(Source:  Added at 33 Ill. Reg. 13246, effective September 8, 2009)