Acute services - State of Illinois

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Revised Inpatient Model With Policy AdjustersAcute services» For COS 20 acute services, revised model components include:› APR-DRG version 29 3M national relative weights re-centerscaled to 1.0 for Illinois Medicaid case mix› Statewide standardized base rate of $4,193.48, with labor portionadjusted for FFY 2012 Medicare IPPS wage index› Medicare outlier policy, with $22,385 fixed stop loss, and 80%marginal cost percentage› Medicare standard transfer-out policy (without post-acute transferpolicy) – prorated payment for cases with length of stay less thanAPR-DRG average› No direct or indirect medical education paymentsPage 6
Revised Inpatient Model With Policy AdjustersAcute services» Baseline model (without policy adjusters) projected a $35.7 milliondecrease in payments (6.6% reduction) for newborn and obstetricalservices combined› HFS and the TAG recognize that newborn and obstetrical services are critical tothe Medicaid program and have a high Medicaid market share› TAG requested that HFS evaluate a policy adjuster for these services» To maintain access to these services, HFS, with support of the TAG, isconsidering a policy adjuster that would maintain current systemfunding levels for newborn and obstetrical services combinedPage 7
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Page 13 and 14: Shadow Pricing ModelsShadow Pricing
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Page 17 and 18: Requested TAG AnalysesRequested ana
Page 19 and 20: Requested TAG AnalysesTransplant Se
Page 21 and 22: Requested TAG AnalysesCapital Cost
Page 23 and 24: Alternative Inpatient Model Update
Page 25 and 26: Transitional CorridorPage 25Example

Acute services - State of Illinois

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