Part 140: MEDICAL PAYMENT

Section 140.362 Pre July 1, 1989 Services (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.220 at 13 Ill. Reg. 9497)

Section 140.363 Post June 30, 1989 Services (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.230 at 13 Ill. Reg. 9497)

Section 140.364 Prepayment Review (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.240 at 13 Ill. Reg. 9497)

Section 140.365 Base Year Costs (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.250 at 13 Ill. Reg. 9497)

Section 140.366 Restructuring Adjustment (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.260 at 13 Ill. Reg. 9497)

Section 140.367 Inflation Adjustment (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.270 at 13 Ill. Reg. 9497)

Section 140.368 Volume Adjustment (Repealed) (Source: Peremptory repealer at 8 Ill. Reg. 18151, effective September 18, 1984)

Section 140.369 Groupings (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.280 at 13 Ill. Reg. 9497)

Section 140.370 Rate Calculation (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.290 at 13 Ill. Reg. 9497)

Section 140.371 Payment (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.300 at 13 Ill. Reg. 9497)

Section 140.372 Review Procedure (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.310 at 13 Ill. Reg. 9497)

Section 140.373 Utilization (Repealed) (Source: Repealed at 13 Ill. Reg. 3351, effective March 6, 1989)

Section 140.374 Alternatives (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.320 at 13 Ill. Reg. 9497)

Section 140.375 Exemptions (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.330 at 13 Ill. Reg. 9497)

Section 140.376 Utilization, Case-Mix and Discretionary Funds (Repealed) (Source: Repealed at 13 Ill. Reg. 3351, effective March 6, 1989)

Section 140.390 Subacute Alcoholism and Substance Abuse Services (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.340 at 13 Ill. Reg. 9497)

Section 140.391 Definitions (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.350 at 13 Ill. Reg. 9497)

Section 140.392 Types of Subacute Alcoholism and Substance Abuse Services (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.360 at 13 Ill. Reg. 9497)

Section 140.394 Payment for Subacute Alcoholism and Substance Abuse Services (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.370 at 13 Ill. Reg. 9497)

Section 140.396 Rate Appeals for Subacute Alcoholism and Substance Abuse Services (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.380 at 13 Ill. Reg. 9497)

Section 140.398 Hearings (Recodified) (Source: Recodified to 89 Ill. Adm. Code 148.390 at 13 Ill. Reg. 9497) SUBPART D: PAYMENT FOR NON-INSTITUTIONAL SERVICES

Section 140.4 Covered Medical Services Under AFDC-MANG for non-pregnant persons who are 18 years of age or older (Repealed) (Source: Repealed at 9 Ill. Reg. 14684, effective September 13, 1985)

Section 140.40 Prior Approval for Medical Services or Items a) The Department may impose prior approval requirements as specified by rule, to determine the essentialness of medical care provided in individual situations. Such requirements shall be based on recommendations of tech…

Section 140.400 Payment to Practitioners a) This Section applies to physicians, dentists, Advanced Practice Registered Nurses (APRN) (see Section 140.435), optometrists, podiatrists, chiropractors, Licensed Clinical Psychologists (LCP) (see Section 140.423) and Licensed Clinical …

Section 140.402 Copayments for Non-institutional Medical Services The following implements cost sharing in compliance with 42 USC 1396o (section 1916 of the Social Security Act): a) Each recipient, with the exception of those classes of recipients identified in subsection (d), sh…

Section 140.403 Telehealth Services a) Definitions 1) "Asynchronous Store and Forward Technology" means the transmission of a patient's medical information from an originating site to the provider at the distant site. The provider at the distant site can review the medical case w…

Section 140.405 Non-Institutional Rate Reductions Notwithstanding any provisions to the contrary in this Part, effective for dates of service on or after July 1, 2012, reimbursement rates and other payments to non-institutional providers shall be reduced by an additional 2.7% fro…

Section 140.41 Prior Approval in Cases of Emergency a) In cases of emergency, the provider may request prior approval by telephoning the office that gives such approval. "Emergency" is defined as a condition or situation which threatens the recipient's life or may cause permanent…

Section 140.410 Physicians' Services a) Payment shall be made only to physicians licensed to practice medicine in all its branches. b) The restrictions and limitations which shall apply to physician participation include the following: 1) Interns are not eligible to participate; …

Section 140.411 Covered Services By Physicians The Department shall pay physicians for the provision of services not otherwise excluded which are: a) Essential for the diagnosis and treatment of a disease or injury; b) Included in the Physicians' Current Procedural Terminology (C…

Section 140.412 Services Not Covered By Physicians Services for which medical necessity is not clearly established are not covered in the Medical Assistance Program. Additionally, the following services are specifically excluded from coverage and payment cannot be made by the Dep…

Section 140.413 Limitation on Physician Services a) When provided in accordance with the specified limitations and requirements, the Department shall pay for the following services: 1) Termination of Pregnancy. All abortion service claims must be accompanied by an HFS 2390 Aborti…

Section 140.414 Requirements for Prescriptions and Dispensing of Pharmacy Items – Prescibers For the purpose of this Section, "prescriber" shall mean any person who, within the scope of his or her professional licensing requirements, may prescribe or dispense drugs. a) Prescripti…

Section 140.416 Optometric Services and Materials a) Payment for optometric services and materials shall be made to physicians, optometrists, opticians and optical companies. b) Payment shall be made for the following optometric services and materials: 1) An eye examination by a …

Section 140.417 Limitations on Optometric Services Payment for the following optometric services and materials shall be made subject to the following limitations: a) Payment shall be made for single vision lenses only when the following conditions are met: 1) The power is at leas…

Section 140.418 Department of Corrections Laboratory All lenses, frames and frame parts shall be obtained from the Department of Corrections (DOC) laboratory and, upon receipt of federal approval of an amendment to the Illinois Title XIX State Plan, a vendor or vendors procured b…

Section 140.42 Limitation on Prior Approval The Department will not give prior approval for an item or service if a less expensive item or service is appropriate to meet the client needs. The Department will not approve purchase of equipment if the client already has equipment wh…

Section 140.420 Dental Services Effective for dates of service on or after July 1, 2014, except as otherwise specified in this Section: a) Except as outlined in subsection (b), payment for dental services shall be made only to enrolled licensed dentists. b) Payment for oral healt…

Section 140.421 Limitations on Dental Services Effective for dates of service on or after July 1, 2018: a) The Department shall impose prior approval requirements to determine the medical necessity of dental services listed in this Section. Prior approval is required for: 1) Crow…

Section 140.422 Requirements for Prescriptions and Dispensing Items of Pharmacy Items – Dentists (Repealed) (Source: Repealed at 33 Ill. Reg. 9048, effective June 15, 2009)

Section 140.423 Licensed Clinical Psychologist Services a) For purposes of enrollment in the Medical Assistance Program, a Licensed Clinical Psychologist (LCP) means a person who is licensed and is legally authorized under State law or rule to practice as a Licensed Clinical Psyc…

Section 140.424 Licensed Clinical Social Worker Services a) For purposes of enrollment in the Medical Assistance Program, a Licensed Clinical Social Worker (LCSW) means a person who is licensed and is legally authorized under State law or rule to practice as a Licensed Clinical S…

Section 140.425 Podiatry Services a) Payment for podiatry services shall be made only to licensed podiatrists. b) Effective July 1, 2012 through September 30, 2014, payment shall be made for those podiatric services provided to recipients under the age of 21 or recipients age 21 …

Section 140.426 Limitations on Podiatry Services a) Payment for an initial visit shall be made only one time for an individual patient to determine whether foot care is required and covered by the Department's program. In partnership or group practices, it is allowed only one tim…

Section 140.427 Acupuncture Services a) For purposes of enrollment in the Medical Assistance Program, an acupuncturist means a person who is licensed and is legally authorized to practice as a licensed acupuncturist, pursuant to the Acupuncture Practice Act [225 ILCS 2] and imple…

Section 140.428 Chiropractic Services a) Payment shall be made only to chiropractors. b) Payment shall be made for only one chiropractic service: manual manipulation of the spine to correct a subluxation of the spine which has resulted in a neuromusculoskeletal condition for whic…

Section 140.429 Limitations on Chiropractic Services (Repealed) (Source: Repealed at 14 Ill. Reg. 4543, effective March 12, 1990)