# 89 Ill. Adm. Code 1480.148.110: Section 148.110 Reimbursement Methodologies for Inpatient Psychiatric Services

> Illinois · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_IL_IAC_T89_P1480_S148_110

## Section

- **Citation:** 89 Ill. Adm. Code 1480.148.110
- **Heading:** Section 148.110 Reimbursement Methodologies for Inpatient Psychiatric Services
- **Jurisdiction:** Illinois
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Illinois Administrative Code / Title 89  /  / Part 1480  / Section 148.110 Reimbursement Methodologies for Inpatient Psychiatric Services

## Text

Section 148
TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 148 HOSPITAL SERVICES
SECTION 148.110 REIMBURSEMENT METHODOLOGIES FOR INPATIENT PSYCHIATRIC SERVICES
Section 148.110  Reimbursement
Methodologies for Inpatient Psychiatric Services
Effective for dates of discharge on or after July 1, 2014:
a)         Inpatient
psychiatric 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
psychiatric 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), (d) or (g), 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 the payment specified in Section 148.290.
c)         Psychiatric
Hospital.  Effective January 1, 2024, payment for inpatient psychiatric
services provided by a psychiatric hospital, as defined in Section
148.25(d)(1):
1)         For
psychiatric hospitals not enrolled with the Department on December 31, 2023,
shall be the product of:
A)        90% of
the minimum rate in subsection (d)(3); and
B)        The
length of stay, as defined in 89 Ill. Adm. Code 149.100(i).
2)         For
psychiatric hospitals enrolled with the Department on December 31, 2023, shall
be the product of:
A)        The greater
of:
i)          The
hospital's psychiatric rate in effect on December 31, 2023 multiplied by 1.1;
or
ii)         90%
of the minimum rate in subsection (d)(3);
B)        The
length of stay, as defined in 89 Ill. Adm. Code 149.100(i).
d)         Distinct
Part Psychiatric Unit
sychiatric hospitals enrolled with the Department on December 31, 2023, shall
be the product of:
A)        The greater
of:
i)          The
hospital's psychiatric rate in effect on December 31, 2023 multiplied by 1.1;
or
ii)         90%
of the minimum rate in subsection (d)(3);
B)        The
length of stay, as defined in 89 Ill. Adm. Code 149.100(i).
d)         Distinct
Part Psychiatric Unit.  Effective January 1, 2024, payment for psychiatric
services provided by a distinct part psychiatric unit, as defined in Section
148.25(c)(1):
1)         Distinct
part psychiatric units that were not enrolled with the Department on December
31, 2023 shall be the product of the following:
A)        90
percent of the minimum rate in subsection (d)(3); and
B)        The
length of stay, as defined in 89 Ill. Adm. Code 149.100(i).
2)         Distinct
part psychiatric units that were enrolled with the Department on December 31,
2023, shall be the product of the following:
A)        The greater
of:
i)          The
rate in effect on December 31, 2023 multiplied by 1.1, or;
ii)         90
percent of the minimum rate in subsection (d)(3).
B)        The length of stay, as
defined in 89 Ill. Adm. Code 149.100(i).
3)         For
Safety Net Hospitals, as defined in 305 ILCS 5/5-5e.1(a), effective January 1, 2024,
the per diem rate for psychiatric services is the greater of:
A)        the
rate in effect on December 31, 2023 multiplied by 1.1; or
B)        the
minimum rate of $693.
4)         For general acute care hospitals that provide
more than 9,500 inpatient psychiatric days in a calendar year, effective
January 1, 2024
, the
per diem rate for psychiatric
services
is as follows:
A)        The
greater of
i)          The
hospital's per diem rate for psychiatric services as of December 31, 2021; or
ii)         $693.
e)         Psychiatric
hospital adjustors for dates of service beginning July 1, 2014
hospitals that provide
more than 9,500 inpatient psychiatric days in a calendar year, effective
January 1, 2024
, the
per diem rate for psychiatric
services
is as follows:
A)        The
greater of
i)          The
hospital's per diem rate for psychiatric services as of December 31, 2021; or
ii)         $693.
e)         Psychiatric
hospital adjustors for dates of service beginning July 1, 2014. For Illinois
freestanding psychiatric hospitals, defined in Section 148.25(d)(1), that were
not children's hospitals as defined in Section 148.25(d)(3) in FY 2013 and
whose Medicaid covered days were 90% or more for individuals under 20 years of
age in FY 2013, the Department shall pay a per day add-on of $48.25.
f)         Effective
January 1, 2022, payment for long-acting injectable antipsychotic drugs and
long-acting injectable substance use disorder drugs administered in the
inpatient psychiatric setting will be reimbursed at the Department's rate.
1)         All
rates are published on the Department's website in the Practitioner Fee
Schedule.
2)         Regarding
long-acting injectable antipsychotics, the following criteria shall be adhered
to regardless of whether the individual is enrolled with a Medicaid Managed
Care Organization or fee-for-service:
A)        The
prescriber must be a board-certified psychiatrist or a board-eligible
psychiatrist. For the purposes of this subsection, a "board-eligible
psychiatrist" is a physician who has, within the past 7 years,
successfully completed residency training accredited by the Accreditation
Council for Graduate Medical Education or approved by the American Board of
Psychiatry and Neurology in a psychiatric primary specialty or subspecialty;
B)        The
injectable atypical antipsychotic agents (AAPI) prior approval will follow the
Food and Drug Administration (FDA) approved labeling for the indication for
each medication; and
C)        The
prescriber agrees to coordinate a follow up outpatient appointment for
administration of the next recommen
ard of
Psychiatry and Neurology in a psychiatric primary specialty or subspecialty;
B)        The
injectable atypical antipsychotic agents (AAPI) prior approval will follow the
Food and Drug Administration (FDA) approved labeling for the indication for
each medication; and
C)        The
prescriber agrees to coordinate a follow up outpatient appointment for
administration of the next recommended dose of the AAPI and provide
documentation of the follow up appointment with request for prior
authorization.

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_IL_IAC_T89_P1480_S148_110. Check the current official text before relying on it. Not legal advice.