§299.1010. Payments

a)         The maximum rate to be used when filing claims for benefits under Title XVIII of the Social Security Act (Medicare) (42 USC 1395b-1), Title XIX of the Social Security Act (Medicaid) (42 USC 1396a), Veteran's Administration benefits (38 USC 521, 541, 542), Champus/Champva (38 USC 601), and active military is not to exceed the rate set by the Illinois Department of Healthcare and Family Services (HFS), or as approved each year for the respective program.  Payments received from a benefit or federal insurance program shall be credited on a dollar for dollar basis for each covered day up to the maximum per capita cost for which the recipient has a liability or the contracted rate established by the provider, whichever is less.

 

b)         All payments received from private hospitalization insurance shall be credited against the person's liability, on a dollar for dollar basis, up to the prevailing maximum charge established in this Section.

 

c)         All payments on behalf of persons from any source shall be credited against Medicaid billings if for the same period of service.

 

d)         If a spouse who is a legal dependent of a recipient is designated as payee of the recipient's benefits and is using those benefits as his/her income, charges shall be established on the total combined income in accordance with the schedule in Table A of this Part.

 

e)         Voluntary payments in excess of required amounts will be accepted from the recipient and from persons not legally responsible.

 

(Source:  Added at 44 Ill. Reg. 8246, effective April 28, 2020)