MedicaidAdministrativeMedium impact
Spenddown Determinations
Illinois Medicaid - HFS·IL · Emergency Medicine, Internal Medicine, General Practice·Provider Notice
Effective date
Dec 23, 2002
We identified it
Jun 21, 2026
Summary
This Illinois Medicaid policy clarifies billing procedures for hospitals when patients have outpatient emergency/observation services, salaried physician services, and inpatient services on the same day for spenddown cases. Hospitals must clearly separate and identify different service charges when submitting to DHS local offices for spenddown calculations.
Action Required
Immediately: For Illinois Medicaid spenddown patients with same-day outpatient emergency/observation and inpatient services, billing team must clearly separate and identify different service charges on billing statements submitted to DHS local offices. Ensure emergency room, observation services, salaried physician services, and inpatient charges are listed separately. Attach DPA 2432 forms when billing for split-bill day services. For inpatient stays crossing calendar months, separate charges by month.