Part 140: MEDICAL PAYMENT

Section 140.482 Family Planning Services a) Payment shall be made for the provision of Family Planning services only to providers who are enrolled to participate in the Medical Assistance Program. b) Family Planning services consisting of contraceptive devices and birth control m…

Section 140.483 Limitations on Family Planning Services Payment for sterilization procedures shall be made only under the following conditions: a) When informed consent as defined under Federal regulations for the Medicaid program (42 CFR 441.250 - 441.259) is given and a consent…

Section 140.484 Payment for Family Planning Services Payment for the specific service or procedure provided shall be made at the usual and customary charge, not to exceed the rates or fees established under the provision of the Department reimbursement schedule, pursuant to the D…

Section 140.485 Healthy Kids Program a) Program Description 1) The Healthy Kids Program is the Early and Periodic Screening, Diagnosis and Treatment Program mandated by the Social Security Act (see 42 USC 1396a(43), 1396d(4)(B) (Supp. 1987)). The goals of the program are to: A) i…

Section 140.486 Illinois Healthy Women a) Benefit coverage under Illinois Healthy Women is available to women meeting the eligibility requirements set forth in 89 Ill. Adm. Code 120.540. b) Covered medical services under Illinois Healthy Women are limited to the following reprodu…

Section 140.487 Healthy Kids Program Timeliness Standards These timeliness standards for required Healthy Kids services or activities apply regardless of the source from which medical or dental care is provided. a) Activity 1: Informing Eligible Families 1) Description: The Depar…

Section 140.488 Periodicity Schedules, Immunizations and Diagnostic Laboratory Procedures a) Health Screening Periodicity Schedule. Eligible clients may receive one periodic health screening during each of the following time periods, except a second screening may be given as expl…

Section 140.490 Medical Transportation a) Payment for medical transportation shall be made to an individual, public, private or not-for-profit transportation carrier, whose operators are properly licensed, who provides the appropriate form of transportation and who bills and rece…

Section 140.491 Medical Transportation Limitations and Authorization Process a) For payment to be made, the transportation service must be to the nearest available appropriate provider, by the least expensive mode that is adequate to meet the individual's need. When public transp…

Section 140.492 Payment for Medical Transportation Notwithstanding the provisions set forth in subsections (a) through (h), beginning July 1, 2002, the reimbursement rates paid for medical transportation services shall be the lesser of the provider's usual and customary charge to…

Section 140.493 Payment for Helicopter Transportation Notwithstanding the provisions set forth in this Section, beginning July 1, 2002, the reimbursement rates paid for helicopter transportation services shall be the lesser of the provider's usual and customary charge to the gene…

Section 140.494 Record Requirements for Medical Transportation Services a) The record must, at a minimum, contain a dispatcher's log and individual trip tickets that document: 1) Identification of the client (name, address and client number); 2) Name and address or facility name …

Section 140.495 Psychological Services a) Payment for the provision of psychological services shall be made to: 1) A psychologist in private practice. 2) State-aided Community Mental Health Clinics. b) Payment shall be made for the provision of diagnostic psychological examinatio…

Section 140.496 Payment for Psychological Services a) Payment is made to a psychologist in private practice in an amount which is the lesser of: 1) The psychologist's usual and customary charges, or 2) The prevailing rate determined by the Department based on the time involved an…

Section 140.497 Hearing Aids a) Hearing aids are reimbursed in accordance with Section 140.481(d). b) In order to be eligible for reimbursement from the Department for monaural and binaural hearing aids, the following criteria must be met: 1) When testing is performed in an acous…

Section 140.498 Fingerprint-Based Criminal Background Checks a) Vendors who pose a risk of fraud, waste, abuse or harm, as defined in Section 140.13, and applicants of the Medical Assistance Program shall submit to a fingerprint-based criminal background check on current and futu…

Section 140.499 Behavioral Health Clinic The Behavioral Health Clinic (BHC) shall: a) Provide community-based mental health services pursuant to Section 140.453; b) Enroll with the Department as a medical provider pursuant to Section 140.11 and comply with Subparts A and B; c) No…

Section 140.5 Covered Medical Services Under General Assistance This program is no longer in effect as of July 1, 2012. (Source: Amended at 37 Ill. Reg. 10282, effective June 27, 2013)

Section 140.500 Long Term Care Services Payments to provide medical long term care services to Medicaid clients shall be made only to facilities licensed by the Illinois Department of Public Health and approved and certified for participation by that Department except such paymen…

Section 140.502 Cessation of Payment at Federal Direction The Department may cease payments for the care of a resident in a long term care facility, who is eligible under the Medical Assistance Program, effective 30 days following the final disqualification of that facility by th…

Section 140.503 Cessation of Payment for Improper Level of Care The Department may cease payments for the care of a resident in a long term care facility, who is eligible under the Medical Assistance Program, effective 30 days following the Department's decision that the facility…

Section 140.504 Cessation of Payment Because of Termination of Facility a) The Department shall cease payments for the care of a Medicaid client residing in an ICF/MR facility effective 30 days following the Department's decision after hearing that the facility be terminated from…

Section 140.505 Informal Hearing Process for Denial of Payment for New ICF/MR Admissions a) The Department may deny payment for new admissions to an Intermediate Care Facility for the Mentally Retarded (ICF/MR) that is found to be out of compliance with the applicable conditions …

Section 140.506 Provider Voluntary Withdrawal a) A long term care facility may voluntarily withdraw from participation in the Medical Assistance Program by notifying the Department in writing at least 60 days prior to the effective date of the withdrawal. b) If a long term care f…

Section 140.507 Continuation of Provider Agreement If the Department continues to pay for a recipient in a group care facility with which the Department no longer has a currently effective provider agreement, the terms of the provider agreement previously in force shall be deemed…

Section 140.510 Determination of Need for Group Care The Department, or its designee, shall verify the initial need for group care in accordance with Section 140.642. The Department shall verify the continued need for group care in accordance with Sections 140.512(b)(3) and (4), …

Section 140.511 Long Term Care Services Covered By Department Payment Skilled nursing facilities and intermediate care facilities (SNF and ICF) and intermediate care facilities for the mentally retarded (ICF/MR) providing long term care to Medicaid eligible residents shall provid…

Section 140.512 Utilization Control Each intermediate care facility for the mentally retarded (ICF/MR) shall have a written Utilization Review (UR) Plan on file that provides necessary information about each client that is necessary for the Department or its designee to perform U…

Section 140.513 Notification of Admissions and Changes in Resident Status a) Long term care providers shall submit all changes in resident status, including, but not limited to, death, discharge, requests for enhanced care rates, changes in patient credit, and third party liabili…

Section 140.514 Certifications and Recertifications of Care (Repealed) (Source: Repealed at 27 Ill. Reg. 14799, effective September 5, 2003)

Section 140.515 Management of Recipient Funds--Personal Allowance Funds a) The recipient, the correspondent or the facility may manage the recipient's personal allowance funds. b) The monthly personal allowance of each recipient is that individual's personal property. The persona…

Section 140.516 Recipient Management of Funds If the recipient manages the funds, that individual shall promptly report changes in circumstances to the local office and notify the local office of any lump sum payment received.

Section 140.517 Correspondent Management of Funds If the correspondent manages the funds, that individual shall: a) Report changes in the recipient's circumstances to the local office; b) Expend the funds for the recipient's benefit; c) Keep an accurate record of all expenditures…

Section 140.518 Facility Management of Funds A facility shall manage a resident's personal funds only upon written authorization from, in order of priority, the resident, the resident's guardian, the resident's representative, or the resident's immediate family member. Such autho…

Section 140.519 Use or Accumulation of Funds The facility or correspondent shall not expend or allow use of recipient funds for any person other than the recipient. The facility and Department shall explain to the recipient or correspondent that funds are not to be spent for the …

Section 140.520 Management of Recipient Funds – Local Office Responsibility The local office shall: a) Review each recipient's personal allowance account during the determination/redetermination process; b) Provide advice and consultation to the recipient regarding handling of pe…

Section 140.521 Room and Board Accounts a) A room and board account is a record of transactions about the patient's cost of care, all monies received which may be applied to the cost of care and the current balance of the account. b) If a facility has a room and board account for…

Section 140.522 Reconciliation of Recipient Funds a) Upon death or discharge of the recipient, the facility shall: 1) File a report of the amount of monies held in the recipient's account with the local office. 2) Promptly refund any money belonging to the recipient or the recipi…

Section 140.523 Bed Reserves a) Effective for dates of service on or after July 1, 2012, no payments for bed reserve days will be made to a facility licensed under the Nursing Home Care Act [210 ILCS 45] or the Specialized Mental Rehabilitation Act [210 ILCS 48]. However, beginni…

Section 140.524 Cessation of Payment Due to Loss of License Payment to a long term care facility for services to Public Aid recipients will cease effective 30 days following notice from the Illinois Department of Public Health that the facility is no longer licensed. (Source: Add…

Section 140.525 Quality Incentive Program (QUIP) Payment Levels a) For the period beginning July 1, 1991, and ending January 31, 1992, Quality Incentive Program (QUIP) payments are: 1) For nursing facilities, the amount they were eligible for under QUIP as of July 1, 1991. Additi…

Section 140.526 County Contribution to Medicaid Reimbursement (Repealed) (Source: Repealed at 34 Ill. Reg. 3761, effective March 14, 2010)

Section 140.527 Quality Incentive Survey (Repealed) (Source: Repealed at 16 Ill. Reg. 19146, effective December 1, 1992)

Section 140.528 Payment of Quality Incentive (Repealed) (Source: Repealed at 16 Ill. Reg. 19146, effective December 1, 1992)

Section 140.529 Reviews (Repealed) (Source: Repealed at 16 Ill. Reg. 19146, effective December 1, 1992)

Section 140.530 Basis of Payment for Long Term-Care Services a) The amount approved for payment for long term care services is based on the type and amount of services required by and actually being furnished to a resident and is determined in accordance with the Department's rat…

Section 140.531 General Service Costs General service costs are allowable as follows: a) Dietary – Allowable dietary costs include salaries and wages earned by those preparing food, serving food, and dishwashing; fees paid to dietary consultants; supplies used in preparing and se…