Section 149.25  General Provisions

Effective for dates of discharge on or after July 1, 2014:

a)         Basis of Payment

1)         Payment on a Per Discharge Basis

A)        Under the DRG PPS, hospitals are paid a predetermined amount per discharge for inpatient hospital services furnished to persons receiving coverage under the Medicaid Program.

B)        The DRG prospective payment rate for each discharge (as defined in subsection (b)) is determined according to the methodology described in Sections 149.100 and 149.150, as appropriate.  An additional payment is made, in accordance with Section 149.105, as appropriate.  The rates paid shall be those in effect on the date of admission.

2)         Payment in Full

A)        The DRG prospective payment amount paid for inpatient hospital services is the total Medicaid payment for the inpatient operating costs  incurred in furnishing services covered under the Medicaid Program.

B)        Except as provided for in Section 149.100(g), the full DRG prospective payment amount, as determined under Section 149.100, is made for each inpatient stay.

(Source:  Amended at 38 Ill. Reg. 15477, effective July 2, 2014)