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pdfCMS 64.21
State: Illinois
Agency: CMS
Quarterly Medical Assistance Expenditures
By Children's Health Insurance Program
Expenditure Categories
Type of Eligible:
1A) Premiums: Up to 150% - Gross Premiums
Paid
1B) Premiums: Up to 150% - Cost Sharing
Offset
1C) Premiums: Over 150% - Gross Premiums
Paid
1D) Premiums: Over 150% - Cost Sharing
Offset
2) Inpatient Hospital Services - Reg.
Payments
2A) Inpatient Hospital Services - DSH
3) Inpatient Mental Health - Reg. Payments
3A) Inpatient Mental Health - DSH
3B) Certified Community Behavioral Health
Clinic Payments 65.62%
5) Physician/Surgical
6) Outpatient Hospital Services
7) Outpatient Mental Health Facility Services
8) Prescribed Drugs
8A1) Drug Rebate - National
8A2) Drug Rebate - State
8A3) MCO - National Agreement
8A4) MCO - State Sidebar Agreement
8A5) Increased ACA OFFSET - Fee for Service 100%
8A6) Increased ACA OFFSET - MCO - 100%
9) Dental Services
10) Vision Services
11) Other Practitioners
12) Clinic Services
13) Therapy Services
14) Laboratory/Radiological
15) Medical Equipment
16) Family Planning
17) Abortions No. 0
18) Screening
19) Home Health
20) Medicare Payments
21) Home And Community
21A) Home and Community-Based Services Regular Payment (WAIVER)
22) Hospice
23) Medical Transportation
24) Case Management
25) Other Services
26) Total
Quarter/Year: Qtr 2nd 2017
Quarter Ended: 03/31/2017
Total Computable
(A)
Federal Share
I.H.S Facility Services Family Planning Services
100%
90%
(C)
(D)
FMAP
50.89%
(B)
Total
Prompt Pay Federal Share
50.89%
(E)
(F)
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
41,018
88
18,247
0
20,874
45
9,286
0
0
0
0
0
0
0
0
0
0
0
0
0
20,874
45
9,286
0
2,000
40,655
33,298
1,312
20,689
16,945
0
0
0
0
0
0
0
0
0
1,312
20,689
16,945
0
55,647
(44,621)
(2,196)
0
0
0
27,346
(22,259)
(1,096)
0
0
0
0
0
0
0
0
0
1,721
(793)
(39)
0
0
0
0
0
0
0
0
0
29,067
(23,052)
(1,135)
0
0
(2,508)
0
15,695
290
17,094
8,191
2,272
8,023
1,798
0
0
27,475
360
0
0
(2,508)
0
7,987
148
8,646
4,168
1,156
4,083
915
0
0
13,982
183
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
94
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(2,508)
0
7,987
148
8,740
4,168
1,156
4,083
915
0
0
13,982
183
0
0
0
0
1,843
2,076
39,788
264,611
0
0
938
1,056
20,248
132,872
0
0
0
0
0
0
0
0
0
0
0
983
0
0
0
0
0
0
0
0
938
1,056
20,248
133,855
| File Type | application/pdf |
| File Title | 64 21U with with new line items |
| Author | Christopher Kessler |
| File Modified | 2016-06-17 |
| File Created | 2016-03-23 |