Directed Payment Calculation: Safety Net Hospitals
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This document sets forth the quarterly and monthly directed payment calculations and payment amounts from Illinois Department of Healthcare and Family Services (HFS) for Safety Net hospitals for the determination period April 1, 2026–June 30, 2026 (with a revised data period for May and June). It affects HFS-classified Safety Net hospitals and managed care organization (MCO) encounter/utilization totals used to calculate payments.
No material clinical or coverage changes in this revision.
Directed Payment Calculation Criteria
Directed payment calculation criteria
Payment allocation criteria for Safety Net hospitals as presented in the calculation file
Inpatient payment calculation
- Inpatient payment = MCO Days * IP Per Day Fixed Pool Value
- IP Per Day Fixed Pool Value = $2,851.91
- Example: Inpatient Fixed Pool Payment (aggregate) = $155,634,640
Outpatient payment calculation
- Outpatient payment = MCO OP Claims * OP Per Claim Fixed Pool Value
- OP Per Claim Fixed Pool Value = $1,133.06
- Example: Outpatient Per Claim Fixed Pool Payment (aggregate) = $217,745,599
Aggregation and output
- Total Directed Payment Qtr Amt = Inpatient Fixed Pool Payment + Outpatient Per Claim Fixed Pool Payment
- Example: Total Directed Payment Qtr Amt (aggregate) = $373,380,240
- Monthly Payment = Total Directed Payment Qtr Amt / 3
- Example: Monthly Payment (aggregate) = $124,460,080
Coding and Fixed Pool Values
| No codes listed |
Required Provider Actions and Authorization
Directed payment output — no authorization rules
This document contains only directed payment calculation outputs for Safety Net hospitals and does not include any prior authorization requirements, provider action instructions, or steps providers must take to obtain payment; it is a payment calculation report only.
Definitions and Metrics
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