89 Ill. Adm. Code 148.290
Adjustments and Reductions to Total Payments
Section 148
Section 148.290 Adjustments
and Reductions to Total Payments
Effective for dates of outpatient
services on or after July 1, 2014 and inpatient discharges on or after July 1,
2014:
a) The adjustments described in this Section, as applicable,
shall be made to reimbursement amounts calculated pursuant to Sections 148.105,
148.110, 148.115, 148.140, 148.160, 148.170, 148.330 and 89 Ill. Adm. Code
149.100 prior to payment. The adjustments are to be applied in the order in
which they are listed in this Section.
b) Adjustments
to base rates made pursuant to 89 Ill. Adm. Code 152.150.
c) Increases in Payments. Supplemental payments pursuant to the
Long Term Acute Care Hospital Quality Improvement Transfer Program Act [210
ILCS 155] in accordance with Section 148.115(f).
d) Reductions
in Payments. The Department's payment obligation shall be reduced by:
1) Charges. Except for reimbursement calculated under Sections
148.140, 148.160 and 148.170, payment shall not exceed the lesser of:
A) The reimbursement amount determined pursuant to subsections (a)
and (b).
B) The allowable charges billed to the Department on the claim.
2) Hospital Rate Reductions. Payment shall be reduced pursuant to
the provisions of 89 Ill. Adm. Code 152.100.
3) Third-party Liability. Hospitals shall determine whether
services are covered, in whole or in part, under any program or under any other
private group indemnification or insurance program or managed care entity. To
the extent that coverage is available, the Department's payment obligation
shall be reduced.
4) Copayments. Copayments are assessed in accordance with Section
148.190.
e) Increases
in Payments. The Department's payments obligations shall be increased, if
applicable, by:
1) Medicaid
high volume adjustment payments pursuant to Section 148.112.
2) Medicaid
percentage adjustment payments pursuant to Section 148.122.
3) DSH adjustment
payments pursuant to Section 148.120.