MedicaidCoverageMedium impact
Revised Rule for Ventilator Services Enhanced Care Rate
Illinois Medicaid - HFS·IL · Pulmonology, Critical Care·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Jun 16, 2026
Summary
Illinois revised rules for ventilator services enhanced care rate requiring 12-month renewals, stricter eligibility criteria (10+ hours daily invasive ventilation with functioning tracheostomy), and enhanced staffing requirements including on-duty respiratory care practitioners and additional trained nursing staff.
Action Required
Before July 1, 2026: Billing team must update Medicaid billing procedures for Illinois nursing facilities providing ventilator services. Implement 12-month renewal tracking system for enhanced care rate requests. Update documentation requirements to verify residents have functioning tracheostomy and receive invasive mechanical ventilation minimum 10 hours daily, 7 days per week. Remove PRN/as-needed ventilator orders from enhanced rate billing. Ensure facility authorization applications account for 30-day minimum processing time.