Date: April 2, 2021
To: Participating Hospitals: Chief Executive Officers; Chief Financial
Officers; and Patient Accounts Managers
Re: Hospital Long Term Care Days Reimbursement
This notice informs hospitals of a payment mechanism
when continued hospital
level of care is no longer necessary and discharge of the patient is delayed
due to the lack of available placement outside of the hospital at the next
level of care. This applies only to inpatient claims for
services paid under the Department’s fee-for-service program and is not
applicable to services provided to patients covered by a HealthChoice
Illinois managed care plan.
Pursuant to 89
Ill. Admin. Code Section 148.50, the Department will consider
reimbursement for days that are not covered by the hospital inpatient stay but
where discharge is not allowable due to the inability to place the patient in a
lower level of care. These days are identified in the rule as hospital long
term care days.
Process for Requesting
Hospital Long Term Care Days
· A hospital must make five
attempts to place the patient in a lower level of care prior to contacting the
Department to apply for hospital long term care days reimbursement. If the
attempts are unsuccessful, hospitals must complete Form
HFS 1329 and submit it via email to hfs.Hospitals@illinois.gov. Hospitals are reminded that the completed form contains protected
health information and HIPAA privacy guidelines should be followed when
emailing the form. Please note, only days that occur on and after the date of
form submittal will be considered for reimbursement. For general acute care
stays that are reimbursed under the DRG system, only days that exceed the
average length of stay for that DRG will be considered for reimbursement.
· An admission through
discharge DRG-reimbursed claim or the final claim of a per diem reimbursed stay,
both of which must identify the non-covered hospital long term care days,
should be submitted to the Department via the usual process. Department staff
will monitor the claim adjudication and when the claim is in paid status, will
HFS 1329 and calculate the number of eligible hospital
long term care days. Each approved hospital long term care day will be
reimbursed at $289.48.
· The Department will
generate an adjustment for the hospital long term care days payment. An Adjustment
Reason Code in the sequence of 8548 through 8555 with description “Reimburse
Hosp LTC Days” will be identified on the Remittance Advice.
Hospitals may submit Form
HFS 1329 for claims with dates of admission beginning July
1, 2019. For claims where the date of admission is prior to April 1, 2021, hospital
long term care days will be reimbursed for all claims where a form is received
noting the five attempted placements, a claim is on file with the Department
with non-covered days reported, and for acute care claims reimbursed under the
DRG system, the administrative days exceed the average length of stay. For the
admission period above, the payment limitation to only days on or after
notification is received by the Department is not applicable.
Questions may be directed to a hospital billing
consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs