Medicaid Illinois – Provider Notice – Practitioner Proposed Rate Adjustments for April 1, 2024, and Claim Reprocessing

The Public Notice dated March 13, 2024, outlined these rate updates. The proposed changes are estimated to result in a $120.8 million annual increase to providers:

• Practitioner rates are being adjusted from initial pricing at 60% of the Medicare rate when the procedure code was first opened for coverage, to 70% of the January 1, 2024, Medicare rate.
• A reimbursement ceiling is being set at 100% of the Medicare rate. Services reimbursing above 100% of Medicare due to fluctuations in Medicare rates over time will be reduced to pay at 100% of Medicare.  Behavioral health and non-cesarian obstetrical services that are currently reimbursed over 100% of the Medicare rate will not be reduced.
• Reimbursement rates for specified mammography procedure codes will be set at 80% of the Medicare rate, though providers eligible for participation in the Department’s Breast Cancer Quality Screening and Treatment Initiative will continue to be paid at 100% of the Medicare rate in accordance with 89 Ill. Admin. Code 140.400(c).

Source: https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/03132024publinoticepractitionerrateincreases.pdf