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.  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).

(Source:  Amended at 49 Ill. Reg. 2024, effective February 10, 2025)