TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 148 HOSPITAL SERVICES
SECTION 148.406 GRADUATE MEDICAL EDUCATION (GME) PAYMENT FOR LARGE PUBLIC HOSPITALS


 

Section 148.406  Graduate Medical Education (GME) Payment for Large Public Hospitals

 

Effective for dates of service starting July 1, 2018 through June 30, 2020, except when specifically designated otherwise in this Section:

 

a)         Inpatient Graduate Medical Education (GME) Payment

 

1)         Definitions. As used in this Section, unless the context requires otherwise:

 

A)        "Medicare cost report" means the Medicare cost report ending in 2015, as reported in Medicare cost reports released on October 19, 2016, with data through September 30, 2016. 

 

B)        "Hospital's Annualized Medicaid Inpatient Intern Resident Cost" is the product of the following factors:

 

i)          Annualized intern and resident costs obtained from Worksheet B Part I, Column 21 and 22 the sum of lines 30 through 43, 50 through 76, 90 through 93, 96 through 98, and 105 through112;

 

ii)         A quotient of: 

 

          The numerator of which is the hospital's Medicaid days (Worksheet S3 Part I, Column 7, Lines 2 through 4, 14 and 16 through 18); and

 

          The denominator of which is the hospital's total days (Worksheet S3 Part I, Column 8, Lines 14 and 16 through18); and.

 

iii)        The quotient of:

 

          The numerator of which is the hospital's total inpatient charges; and

 

          The denominator of which is the hospital's total charges.

 

C)        "Hospital Annualized Medicaid Indirect Medical Education (IME) Payment" is the product of the following factors:

 

i)          Hospital IME payments (Worksheet E Part A, Line 29, Col 1); and

 

ii)         The quotient of:

 

          The numerator of which is the hospital Medicaid days (Worksheet S3 Part I, Column 7, Lines 2 through 4, 14 and 16 through 18), and

 

          The denominator of which is the hospital Medicare days (Worksheet S3 Part I, Column 6, Lines 2 through 4, 14 and 16 through 18).

 

2)         Qualifying Criteria: An Illinois large public hospital reporting intern and resident cost on its Medicare cost report ending in 2015 shall be eligible for an inpatient GME payment.

 

3)         Payment. A qualifying large public hospital shall receive a payment that is the sum of each large public hospital's annualized Medicaid Intern Resident Cost and annualized Medicaid IME payment.

 

b)         Outpatient (GME) Payment

 

1)         Definitions. As used in this Section, unless the context requires otherwise:

 

A)        "Medicare Cost Report" means the Medicare cost report ending in 2015, as reported in Medicare cost reports released on October 19, 2016, with data through September 30, 2016.

 

B)        "Hospital's Annualized Medicaid Outpatient Intern Resident Cost" is the product of the following factors:

 

i)          Annualized intern and resident costs obtained from Worksheet B Part I, Column 21 and 22 the sum of lines 30 through 43, 50 through 76, 90 through 93,96 through 98, and 10 through 112; and

 

ii)         A quotient of:

 

          the numerator of which is the hospital's Medicaid days (Worksheet S3 Part I, Column 7, Lines 2 through 4, 14 and 16 through 18); and

 

          the denominator of which is the hospital's total days (Worksheet S3 Part I, Column 8, Lines 14 and 16 through 18); and

 

C)        The quotient of:

 

i)          The numerator of which is the hospital's total outpatient charges; and

 

ii)         The denominator of which is the hospital's total charges.

 

2)         Qualifying Criteria: A large public hospital reporting intern and resident cost on its Medicare cost report ending in 2015 shall be eligible for a outpatient graduate medical education payment.

 

3)         Payment. A qualifying large public hospital shall receive an outpatient GME payment that is equal to subsection (d)(2).

 

(Source:  Former Section repealed at 33 Ill. Reg. 501, effective December 30, 2008; new Section adopted at 42 Ill. Reg. 22401, effective November 29, 2018)