Section 148.200  Critical Access Hospital OB and Other Treatment Services Payment (CAHOOTS)

a)         To qualify for CAHOOTS payments, pursuant to 305 ILCS 5/5A-12.7(o) or 305 ILCS 5/14-12.7, a hospital must meet the following criteria:

1)         Be located in Illinois; and

2)         Meet the definition of a Critical Access Hospital as defined in Section 148.25(g).

b)         Each hospital qualifying under subsection (a) that is owned or operated by an Illinois government body or municipality, shall be paid a quarterly CAHOOTS payment equal to the product of:

1)         $875,000; and.

2)         The lower of:

A)        A quotient of:

i)          the numerator of which is the hospital's adjusted outpatient claims in the data quarter; and

ii)         the denominator of which is the total of all qualifying hospitals' adjusted outpatient claims in the data quarter; or

B)        10%.

c)         Each hospital qualifying under subsection (a) that is not owned or operated by an Illinois government body or municipality, shall be paid a quarterly CAHOOTS payment equal to the product of:

1)         $2,500,000; and.

2)         The lower of:

A)        A quotient of:

i)          the numerator of which is the hospital's adjusted outpatient claims in the data quarter; and

ii)         the denominator of which is the total of all qualifying hospitals' adjusted outpatient claims in the data quarter; or,

B)        10%.

d)         Any funds that remain after the payments described in in subsections (b) and (c) are complete will be distributed to qualifying hospitals in the payment quarter that have not reached the 10% limitations. These payments will be equal to the product of:

1)         All remaining funds; and

2)         A quotient of:

A)        The numerator of which is the hospital's total adjusted outpatient claims in the data quarter; and

B)        The denominator of which is the total of all qualifying hospitals' adjusted outpatient claims in the data quarter for those hospitals that have not reached the 10% limitation.

e)         Definitions

1)         "Adjusted Outpatient Claims" means the number of paid MCO encounter outpatient claims for services covered under Title XIX of the Social Security Act, excluding days for individuals eligible for Medicare under Title XVIII of the Social Security Act (Medicaid/Medicare crossover days), received by the Department during the data quarter multiplied by 1.5 for qualifying hospitals that are designated as a perinatal hospital with the Illinois Department of Public Health during the payment quarter or multiplied by 1.0 for qualifying hospitals that do not have that designation.

2)         "Data Quarter" means the quarter of the calendar year that begins six months and ends three months prior to the payment period.

3)         "Payment Quarter" means the quarter of the calendar year that the payments will be made.

(Source:  Former Section repealed at 38 Ill. Reg. 15165, effective July 2, 2014; new Section added at 50 Ill. Reg. 7685, effective May 20, 2026)