MedicaidReimbursementMedium impact
COST OUTLIER PAYMENT CALCULATION REVISION
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2005
We identified it
Jun 21, 2026
Summary
Illinois Healthcare and Family Services revised cost outlier payment calculations for hospital admissions starting July 1, 2005. DRG-reimbursed hospitals must multiply the Specific Fixed Loss Threshold by 1.40, while per diem-reimbursed hospitals use a factor of 0.20 in outlier calculations.
Action Required
Immediately: Hospitals billing Illinois Medicaid must update Handbook for Hospitals by replacing appendix pages H-22f (4), (4a), and (4b) dated December 2001 with updated pages dated August 2005. Download replacement pages from https://hfs.illinois.gov/ or request paper copies. Update cost outlier payment calculation systems to apply new factors for admissions on/after July 1, 2005.