Part 140: MEDICAL PAYMENT

Section 140.649 Effective Dates of Reimbursement for Developmental Training (DT) Programs a) The effective date of reimbursement to the facility for DT services will be the later of the dates when the following criteria have been met: 1) receipt by the Department of an addendum t…

Section 140.650 Certification of Developmental Training (DT) Programs In order for a facility to qualify for reimbursement DT services, it must execute a written agreement with a DT program that is certified by the Department of Mental Health and Developmental Disabilities (DMHDD…

Section 140.651 Decertification of Day Programs a) The Department of Mental Health and Developmental Disabilities (DMHDD) is responsible for decertification of DT Programs. When a DT Program has been decertified by the DMHDD, it may appeal the decertification in accordance with r…

Section 140.652 Terms of Assurances and Contracts A facility requesting reimbursement for developmental training (DT) services provided by a DMHDD certified DT program must submit to the Department an addendum to its provider agreement (Form DPA 1432) containing an assurance that…

Section 140.680 Effective Date of Payment Rate a) Notwithstanding any other provisions of these rules, there shall be no rate increase for long term care facilities for Calendar Year 1983, or the first six months of Calendar Year 1984. b) For Calendar Year 1984 and subsequent yea…

Section 140.7 Medical Assistance Provided to Individuals Under the Age of Eighteen Who Do Not Qualify for AFDC and Children Under Age Eight a) Individuals Under Age Eighteen (18) 1) Medical assistance shall be provided to individuals under the age of eighteen who do not qualify f…

Section 140.700 Discharge of Long Term Care Residents a) A nursing facility participating in the Medical Assistance Program is prohibited from failing or refusing to retain as a resident any person because he or she is a recipient or an applicant for the Medical Assistance Progra…

Section 140.71 Reimbursement for Medical Services Through the Use of a C-13 Invoice Voucher Advance Payment and Expedited Payments a) C-13 Invoice Voucher Advance Payments 1) The C-13 invoice voucher, when used as an advanced payment, is an exception to the regular reimbursement …

Section 140.72 Drug Manual (Recodified) (Source: Recodified to 89 Ill. Adm. Code 141 at 8 Ill. Reg. 16354)

Section 140.73 Drug Manual Updates (Recodified) (Source: Recodified to 89 Ill. Adm. Code 141 at 8 Ill. Reg. 16354)

Section 140.74 Resolution of Claims Related to Inaccurate or Updated Enrollment Information a) Payment shall be made for a medically necessary covered service when payment is initially denied due to inaccurate or updated enrollment information on the date of service when the prov…

Section 140.75 Managed Care − Disputed Provider Claims Resolution Process a) The Department will maintain an electronic provider complaint portal through which a disputed claim between a provider and an MCO is documented, monitored, and resolved. A disputed claim is a determinati…

Section 140.76 Hospital Managed Care Utilization Review Standardization and Transparency Practices a) Definitions. As used in this Section: "Administrative days" means hospital long term care days as defined in 89 Ill. Adm. Code 148.50(c)(1). "Adverse benefit determination" means…

Section 140.8 Medical Assistance For Qualified Severely Impaired Individuals Medical assistance shall be provided under the AABD program to a qualified severly impaired individual whose Supplemental Security Income (SSI) payment status is based on Section 1619 of the Social Secur…

Section 140.80 Hospital Provider Fund a) Purpose and Contents 1) The Hospital Provider Fund (Fund) was created in the State Treasury on February 3, 2004 (see 305 ILCS 5/5A-8). Interest earned by the Fund shall be credited to the Fund. The Fund shall not be used to replace any fun…

Section 140.82 Developmentally Disabled Care Provider Fund a) Purpose and Contents 1) The Developmentally Disabled Care Provider Fund was created in the State Treasury on July 1, 1992, July 14, 1993 and July 1, 1995 (see 305 ILCS 5/5C-7). Interest earned by the Fund shall be cred…

Section 140.830 Appeals of Rate Determinations a) Except as indicated in subsection (b), the Department shall notify all nursing facilities of their support and capital rates annually. Appeals of rate determinations shall be submitted in writing to the Department. Except as indic…

Section 140.835 Determination of Cap on Payments for Long Term Care (Repealed) (Source: Repealed at 16 Ill. Reg. 6408, effective March 20, 1992) SUBPART F: FEDERAL CLAIMING FOR STATE AND LOCAL GOVERNMENTAL ENTITIES

Section 140.84 Long Term Care Provider Fund a) Purpose and Contents 1) The Long Term Care Provider Fund was created in the State Treasury on July 1, 1992, July 14, 1993 and July 1, 1995 (see Section 5B-8 of the Code). Interest earned by the Fund shall be credited to the Fund. The…

Section 140.850 Reimbursement of Administrative Expenditures The Department may seek federal reimbursement for expenditures incurred by other State agencies and local government entities that are in support of any medical assistance program or programs administered by the Departm…

Section 140.855 Administrative Claim Review and Reconsideration Procedure a) The Department may reject all or any portion of a claim for federal reimbursement that is not in compliance with State or federal law, regulation, policy or applicable intergovernmental or interagency ag…

Section 140.86 Supportive Living Facility Fund a) Purpose and Contents 1) The Supportive Living Facility Fund was created in the State Treasury on July 1, 2014 (see 305 ILCS 5/5G-35). Interest earned by the Fund shall be credited to the Fund. The Fund shall not be used to replace…

Section 140.860 County Owned or Operated Nursing Facilities a) Subject to federal approval, the Department shall draw the eligible amounts of federal monies for the covered expenditures in accordance with Section 140.530(c)(2), intergovernmental agreements between the county and …

Section 140.865 Sponsor Qualifications (Repealed) (Source: Repealed at 18 Ill. Reg. 18059, effective December 19, 1994)

Section 140.870 Sponsor Responsibilities (Repealed) (Source: Repealed at 18 Ill. Reg. 18059, effective December 19, 1994)

Section 140.875 Department Responsibilities (Repealed) (Source: Repealed at 18 Ill. Reg. 18059, effective December 19, 1994)

Section 140.88 Managed Care Organization Provider Assessment a) Definitions 1) "Base Year" means the 12 month period from January 1, 2018 to December 31, 2018 2) "Department" means the Department of Healthcare and Family Services. 3) "Federal employee health benefit" means the pr…

Section 140.880 Provider Qualifications (Repealed) (Source: Repealed at 18 Ill. Reg. 18059, effective December 19, 1994)

Section 140.885 Provider Responsibilities (Repealed) (Source: Repealed at 18 Ill. Reg. 18059, effective December 19, 1994)

Section 140.890 Payment Methodology (Repealed) (Source: Repealed at 18 Ill. Reg. 18059, effective December 19, 1994)

Section 140.895 Contract Monitoring (Repealed) (Source: Repealed at 18 Ill. Reg. 18059, effective December 19, 1994)

Section 140.896 Reimbursement For Program Costs (Active Treatment) For Clients in Long Term Care Facilities For the Developmentally Disabled (Recodified) (Source: Recodified to 89 Ill. Adm. Code 146.225 at 13 Ill. Reg. 7040) SUBPART G: MATERNAL AND CHILD HEALTH PROGRAM

Section 140.9 Medical Assistance for a Pregnant Woman Who Would Not Be Categorically Eligible for AFDC/AFDC-MANG if the Child Were Already Born Or Who Do Not Qualify As Mandatory Categorically Needy a) Pregnant Women Who Would Not Be Categorically Eligible for AFDC/AFDC‑MANG if t…

Section 140.900 Reimbursement For Nursing Costs For Geriatric Residents In Group Care Facilities (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.5 at 12 Ill. Reg. 6956)

Section 140.901 Functional Areas of Needs (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.25 at 12 Ill. Reg. 6956)

Section 140.902 Service Needs (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.50 at 12 Ill. Reg. 6956)

Section 140.903 Definitions (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.75 at 12 Ill. Reg. 6956)

Section 140.904 Times and Staff Levels (Repealed) (Source: Repealed at 11 Ill. Reg. 16758, effective September 28, 1987)

Section 140.905 Statewide Rates (Repealed) (Source: Amended at 11 Ill. Reg. 16758, effective September 28, 1987)

Section 140.906 Reconsiderations (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.150 at 12 Ill. Reg. 6956)

Section 140.907 Midnight Census Report (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.105 at 12 Ill. Reg. 6956)

Section 140.908 Times and Staff Levels (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.125 at 12 Ill. Reg. 6956)

Section 140.909 Statewide Rates (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.150 at 12 Ill. Reg. 6956)

Section 140.910 Referrals (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.175 at 12 Ill. Reg. 6956)

Section 140.911 Basic Rehabilitation Aide Training Program (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.200 at 12 Ill. Reg. 6956)

Section 140.912 Interim Nursing Rates (Recodified) (Source: Recodified to 89 Ill. Adm. Code 147.250 at 12 Ill. Reg. 6956)

Section 140.920 General Description a) The Maternal and Child Health Program is a primary health care program coupled with case management services for Medicaid enrolled pregnant women and children. The program is designed to ensure access to quality health care services. b) Case…