Section 148.105 Reimbursement Methodologies for Inpatient Rehabilitation Services

TITLE 89: SOCIAL SERVICES

CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SUBCHAPTER d: MEDICAL PROGRAMS

PART 148 HOSPITAL SERVICES

SECTION 148.105 REIMBURSEMENT METHODOLOGIES FOR INPATIENT REHABILITATION SERVICES

Section 148.105  Reimbursement

Methodologies for Inpatient Rehabilitation Services

Effective with discharges on

or after July 1, 2014:

a)         Inpatient rehabilitation services not

excluded from the DRG PPS pursuant to 89 Ill. Adm. Code 149.50(b) shall be reimbursed

through the DRG PPS.

b)         Inpatient rehabilitation services excluded

from the DRG PPS shall be reimbursed a hospital-specific rate paid per day of

covered inpatient care, determined pursuant to subsection (c) or (d), as

applicable.  The total payment for an inpatient stay will equal the sum of:

1)         the payment determined in this Section; and

2)         any applicable adjustments to payment

specified in Section 148.290.

c)         Rehabilitation Hospital.  Effective January

1, 2024, payment for inpatient rehabilitation services provided by a

rehabilitation hospital, as defined in Section 148.25(d)(2):

1)         That was not enrolled with the Department on

December 31, 2023, shall be the product of the following:

A)        $1,000.67; and

B)        The length of stay, as defined in 89 Ill.

Adm. Code 149.100(i).

2)         That was enrolled with the Department on

December 31, 2023, shall be the product of the following:

A)        The

greater of:

i)          the hospital's rehabilitation rate in

effect on December 31, 2023 multiplied by 1.1; or

ii)         $1,000.67.

B)        The length of stay, as defined in 89 Ill.

Adm. Code 149.100(i).

d)         Distinct Part Rehabilitation Unit

. Code 149.100(i).

2)         That was enrolled with the Department on

December 31, 2023, shall be the product of the following:

A)        The

greater of:

i)          the hospital's rehabilitation rate in

effect on December 31, 2023 multiplied by 1.1; or

ii)         $1,000.67.

B)        The length of stay, as defined in 89 Ill.

Adm. Code 149.100(i).

d)         Distinct Part Rehabilitation Unit.  Effective

January 1, 2024, payment for inpatient rehabilitation services provided by a

distinct part rehabilitation unit, as defined in Section 148.25(c)(2):

1)         For which was not enrolled with the

Department on December 31, 2023, shall be the product of the following:

A)        $593.25; and

B)        The length of stay, as defined in 89 Ill.

Adm. Code 149.100(i).

2)         For which was enrolled with the Department on

December 31, 2023, shall be the product of the following:

A)        The greater of:

i)          The distinct part rehabilitation rate in

place on December 31, 2023 multiplied by 1.1; or

ii)         $593.25.

B)        The length of stay, as defined in 89 Ill.

Adm. Code 149.100(i).