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

Section 148

TITLE 89: SOCIAL SERVICES

CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SUBCHAPTER d: MEDICAL PROGRAMS

PART 148 HOSPITAL SERVICES

SECTION 148.200 CRITICAL ACCESS HOSPITAL OB AND OTHER TREATMENT SERVICES PAYMENT (CAHOOTS)

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

nt 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.