TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 148 HOSPITAL SERVICES
SECTION 148.126 SAFETY NET ADJUSTMENT PAYMENTS


 

Section 148.126  Safety Net Adjustment Payments

 

Effective for dates of service on or after July 1, 2014, except when specifically designated otherwise in this Section:

 

a)         Qualifying criteria:  Safety net adjustment payments shall be made to a qualifying hospital, as defined in this subsection (a), unless the hospital does not provide comprehensive emergency treatment services as defined in 77 Ill. Adm. Code 250.710(a) on or after July 1, 2006, but did provide comprehensive emergency treatment services as defined in 77 Ill. Adm. Code 250.710(a) on January 1, 2006.  A hospital not otherwise excluded under subsection (b) shall qualify for payment if it meets one of the following criteria:

 

1)         Prior to July 1, 2018, the hospital has, as provided in subsection (e)(6), an MIUR equal to or greater than 40 percent.

 

2)         Prior to July 1, 2018, the hospital is, as of October 1, 2001, a rural hospital, as described in Section 148.446(a)(1), that meets all of the following criteria:

 

A)        Has an MIUR greater than 33 percent.

 

B)        Is designated a perinatal level two center by the Illinois Department of Public Health.

 

C)        Has fewer than 125 licensed beds.

 

3)         Prior to July 1, 2018, the hospital meets all of the following criteria:

 

A)        Has an MIUR greater than 30 percent.

 

B)        Had an occupancy rate greater than 80 percent in the safety net hospital base year.

 

C)        Provided greater than 15,000 total days in the safety net hospital base year.

 

4)         The hospital meets all of the following criteria:

 

A)        Does not already qualify under subsections (a)(1) through (a)(3).

 

B)        Has an MIUR greater than 25 percent.

 

C)        Had an occupancy rate greater than 68 percent in the safety net hospital base year.

 

D)        Provided greater than 12,000 total days in the safety net hospital base year.

 

5)         Prior to July 1, 2018, the hospital meets all of the following criteria in the safety net base year:

 

A)        Is a psychiatric hospital, as described in Section 148.25(d)(1).

 

B)        Has licensed beds greater than 120.

 

C)        Has an average length of stay less than 10 days.

 

6)           The hospital meets all of the following criteria in the safety net base year:

 

A)        Does not already qualify under subsections (a)(1) through (a)(5) of this Section.

 

B)        Has an MIUR greater than 17 percent.

 

C)        Has licensed beds greater than 450.

 

D)        Has an average length of stay less than four days.

 

7)           Prior to July 1, 2018, the hospital meets all of the following criteria in the safety net base year:

 

A)        Does not already qualify under subsections (a)(1) through (a)(6) of this Section.

 

B)        Has an MIUR greater than 21 percent.

 

C)        Has licensed beds greater than 350.

 

D)        Has an average length of stay less than 3.15 days.

 

8)           Prior to July 1, 2018, the hospital meets all of the following criteria in the safety net base year:

 

A)        Does not already qualify under subsections (a)(1) through (a)(7) of this Section.

 

B)        Has a Combined MIUR greater than 25 percent.

 

C)        Has an MIUR greater than 12 percent.

 

D)        Is designated a perinatal Level II center by the Illinois Department of Public Health.

 

E)        Has licensed beds greater than 400.

 

F)         Has an average length of stay less than 3.5 days.

 

9)          Prior to July 1, 2018, the hospital meets all of the following criteria in the safety net base year:

 

A)        Does not already qualify under subsections (a)(1) through (a)(8) of this Section.

 

B)        Is located outside Health Service Area (HSA) 6.

 

C)        Has an MIUR greater than 16%.

 

D)        Has licensed beds greater than 475.

 

E)        Has an average length of stay less than five days.

 

10)           The hospital meets all of the following criteria in the safety net base year:

 

A)        Provided greater than 5,000 obstetrical care days.

 

B)        Has a combined MIUR greater than 80%.

 

11)           The hospital meets all of the following criteria in the safety net base year:

 

A)        Does not already qualify under subsections (a)(1) through (a)(10) of this Section.

 

B)        Has a CMIUR greater than 28 percent.

 

C)        Is designated a perinatal Level II center by the Illinois Department of Public Health.

 

D)        Has licensed beds greater than 320.

 

E)        Had an occupancy rate greater than 37 percent in the safety net hospital base year.

 

F)         Has an average length of stay less than 3.1 days.

 

12)           The hospital meets all of the following criteria in the safety net base year:

 

A)        Does not already qualify under subsections (a)(1) through (a)(11) of this Section.

 

B)        Is a general acute care hospital.

 

C)        Is designated a perinatal Level II center by the Illinois Department of Public Health.

 

D)        Provided greater than 1,000 rehabilitation days in the safety net hospital base year.

 

b)         For a hospital qualifying under subsection (a)(1) that is neither a rehabilitation hospital nor a children's hospital, that is located outside HSA 6, that has an MIUR greater than 50 per centrum, and that:

 

1)         Provides obstetrical care – $210.00 for dates of service on or after July 1, 2014 through June 30, 2018.  For dates of service on or after July 1, 2018, the rate is $0.00.

 

2)         Does not provide obstetrical care – $90.00 for dates of service on or after July 1, 2014 through June 30, 2018.  For dates of service on or after July 1, 2018, the rate is $0.00.

 

c)         For a hospital qualifying under subsection (a)(2), the rate shall be $55.00 for dates of service on or after July 1, 2014 through June 30, 2018.  For dates of service on or after July 1, 2018, the rate is $0.00.

 

d)         For a hospital qualifying under subsection (a)(3), the rate shall be $3.00 on or after July 1, 2014.  For dates of service on or after July 1, 2018, the rate is $0.00. 

 

e)         For a hospital qualifying under subsection (a)(4), the rate shall be $140.00 on or after July 1, 2014.  Effective July 1, 2018, the rate is $105.00.

 

f)         For a hospital qualifying under subsection (a)(5), the rate shall be $119.50 on or after July 1, 2014 through June 30, 2018.  For dates of service on or after July 1, 2018, the rate is $0.00.

 

g)         For a hospital qualifying under subsection (a)(7), the rate shall be $221.00 on or after July 1, 2014 through June 30, 2018.  For dates of service on or after July 1, 2018, the rate is $0.00.

 

h)         For a hospital qualifying under (a)(8), the rate shall be $100.00 on or after July 1, 2014 through June 30, 2018.  For dates of service on or after July 1, 2018, the rate is $0.00.

 

i)          For a hospital qualifying under subsection (a)(9), the rate shall be $69.00 on or after July 1, 2014 through June 30, 2018.  For dates of service on or after July 1, 2018, the rate is $0.00. 

 

j)          For a hospital qualifying under subsection (a)(10), the rate is $56.00 for dates of service through February 28, 2014.  For dates of service on or after March 1, 2014 through June 30, 2014, the rate is $136.00.  For dates of service on or after July 1, 2014, the rate is $56.00. Effective July 1, 2018, the rate is $40.00.

 

k)         For a hospital qualifying under subsection (a)(11) of this Section, the rate is $197.00 on or after July 1, 2014.

 

l)          For a hospital qualifying under subsection (a)(6) of this Section, the rate is $25.00 on or after July 1, 2014.

 

m)        For a hospital qualifying under subsection (a)(12), the rate is $71.00 on or after July 1, 2014.           

 

n)         Payment to a Qualifying Hospital

 

1)         The total annual payments to a qualifying hospital shall be the product of the hospital's rate multiplied by two multiplied by total days.

 

2)         For safety net adjustment periods occurring after State fiscal year 2010, total payments made under this Section shall be paid in installments on, at least, a quarterly basis.

 

3)         The product of subsection (n)(1) will be multiplied by the applicable tiering of Section 148.296(d).

 

o)         Definitions

 

1)         "Average length of stay" means, for a given hospital, a fraction in which the numerator is the number of total days and the denominator is the number of total admissions.

 

2)         "CMIUR" means, for a given hospital, the sum of the MIUR plus the Medicaid obstetrical inpatient utilization rate, determined as of October 1, 2001, as defined in Section 148.122(g)(3).

 

3)         "General care admissions" means, for a given hospital, the number of hospital inpatient admissions for recipients of medical assistance under Title XIX of the Social Security Act, as tabulated from the Department's claims data for admissions occurring in the safety net hospital base year that were adjudicated by the Department by June 30, 2001, excluding admissions for:  obstetrical care, as defined in subsection (m)(7); normal newborns; psychiatric care; physical rehabilitation; and those covered in whole or in part by Medicare (Medicaid/Medicare crossover admissions).

 

4)         "HSA" means Health Service Area, as defined by DPH.

 

5)         "Licensed beds" means, for a given hospital, the number of licensed beds, excluding long term care and substance abuse beds, as listed in the July 25, 2001, DPH report entitled "Percent Occupancy by Service in Year 2000 for Short Stay, Non-Federal Hospitals in Illinois."

 

6)         "MIUR", for a given hospital, has the meaning as defined 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 2002 shall be the same determination used to determine a hospital's eligibility for safety net adjustment payments in the Safety Net Adjustment Period.

 

7)         "Obstetrical care admissions" means, for a given hospital, the number of hospital inpatient admissions for recipients of medical assistance under Title XIX of the Social Security Act, as tabulated from the Department's claims data, for admissions occurring in the safety net hospital base year that were adjudicated by the Department through June 30, 2001, and were assigned by the Department a diagnosis related grouping (DRG) code of 370 through 375.

 

8)         "Obstetrical care days" means, for a given hospital, days of hospital inpatient service associated with the obstetrical care admissions described in subsection (o)(7).

 

9)         "Occupancy rate" means, for a given hospital, a fraction, the numerator of which is the hospital's total days, excluding long term care and substance abuse days, and the denominator of which is the hospital's total beds, excluding long term care and substance abuse beds, multiplied by 365 days.  The data used for calculation of the hospital occupancy rate is as listed in the July 25, 2001, Illinois Department of Public Health report entitled "Percent Occupancy by Service in Year 2000 for Short Stay, Non-Federal Hospitals in Illinois".

 

10)         "Safety net hospital base year" means the 12-month period beginning on July 1, 1999, and ending on June 30, 2000.

 

11)         "Safety net adjustment period" means, beginning July 1, 2002, the 12 month period beginning on July 1 of a year and ending on June 30 of the following year.

 

12)         "Total admissions" means, for a given hospital, the number of hospital inpatient admissions for recipients of medical assistance under Title XIX of the Social Security Act, excluding admissions for individuals eligible for Medicare under Title XVIII of that Act (Medicaid/Medicare crossover admissions), as tabulated from the Department's claims data for admissions occurring in the safety net hospital base year that were adjudicated by the Department through June 30, 2001.

 

13)         "Total days" means, for a given hospital, the sum of days of inpatient hospital service provided to recipients of medical assistance under Title XIX of the federal Social Security Act, excluding days for individuals eligible for Medicare under Title XVIII of that Act (Medicaid/Medicare crossover days), as tabulated from the Department's claims data for admissions occurring in the safety net hospital base year that were adjudicated by the Department through June 30, 2001.

 

p)       Payment Limitations:  In order to be eligible for any new payment or rate increase under this Section that would otherwise become effective for dates of service on or after July 1, 2010, a hospital located in a geographic area of the State in which the Department mandates some or all of the beneficiaries of the Medical Assistance Program residing in the area to enroll in a Care Coordination program as defined in 305 ILCS 5/5-30 must be a Coordinated Care Participating  Hospital as defined in Section 148.295(b)(5).  The payment limitation takes effect 60 days, unless extended by the Department in its sole discretion, after the Department begins mandatory enrollment in the geographic area.

 

q)         Expiration of Payment Criteria and Rates. The payment criteria and corresponding rates found in subsections (a)(1) through (a)(3), (a)(5), (a)(7), (a)(9), (b), (c), (d), (f), (g), (h), and (i) are no longer in effect as of July 1, 2018.

 

(Source:  Amended at 42 Ill. Reg. 22401, effective November 29, 2018)