Section 140.3 Covered Services Under Medical Assistance Programs
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Illinois Administrative Code › Title 89 SOCIAL SERVICES › CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES › Part 140 MEDICAL PAYMENT › Section 140.3 Covered Services Under Medical Assistance Programs
Text
Section 140
Section 140.3 Covered
Services Under Medical Assistance Programs
a) As
described in this Section, medical services shall be covered for:
1) recipients of financial assistance under the AABD (Aid to the
Aged, Blind or Disabled), TANF (Temporary Assistance to Needy Families), or
Refugee/Entrant/Repatriate program;
2) recipients of medical assistance only under the AABD program
(AABD-MANG);
3) recipients of medical assistance only under the TANF program
(TANF-MANG);
4) individuals under age 18 not eligible for TANF (see Section
140.7), pregnant women who would be eligible if the child were born and
pregnant women and children under age eight who do not qualify as mandatory
categorically needy (see Section 140.9);
5) disabled persons under age 21 who may qualify for Medicaid or
in-home care under the Illinois Home and Community-Based Services Waiver for
Medically Fragile Technology Dependent Children;
6) individuals 19 years of age or older eligible under the
KidCare Parent Coverage Waiver described at 89 Ill. Adm. Code 120.32, except
for services provided only through a waiver approved under section 1915(c) of
the Social Security Act (42 U.S.C. 1396n(c));
7) beginning January 1, 2014, ACA Adults as described in 89 Ill.
Adm. Code 120.10(h). Notwithstanding any rule to the contrary in Title 89, the
services that shall be covered are services for which the Department obtains
federal approval and receives federal matching funds; and
8) beginning
January 1, 2014, Former Foster Care as described in 89 Ill. Adm. Code
120.10(i).
b) The following medical services shall be covered for recipients
under age 21 who are included under subsection (a):
1) Inpatient hospital services;
2) Hospital outpatient and clinic services;
3) Hospital emergency room visits
eceives federal matching funds; and
8) beginning
January 1, 2014, Former Foster Care as described in 89 Ill. Adm. Code
120.10(i).
b) The following medical services shall be covered for recipients
under age 21 who are included under subsection (a):
1) Inpatient hospital services;
2) Hospital outpatient and clinic services;
3) Hospital emergency room visits. The visit must be for the
alleviation of severe pain or for immediate diagnosis and/or treatment of
conditions or injuries that might result in disability or death if there is not
immediate treatment;
4) Encounter rate clinic visits;
5) Physician services;
6) Pharmacy services;
7) Home health agency visits;
8) Laboratory and x-ray services;
9) Group care services;
10) Family planning services and supplies;
11) Medical supplies, equipment, prostheses and orthoses, and
respiratory equipment and supplies;
12) Transportation to secure medical services;
13) EPSDT services pursuant to Section 140.485;
14) Dental services;
15) Chiropractic services;
16) Podiatric services;
17) Optical services and supplies;
18) Subacute alcoholism and substance abuse services pursuant to
Sections 140.390 through 140.396;
19) Hospice services;
20) Nursing
care pursuant to Section 140.472;
21) Nursing
care for the purpose of transitioning children from a hospital to home
placement or other appropriate setting pursuant to 89 Ill. Adm
ervices;
17) Optical services and supplies;
18) Subacute alcoholism and substance abuse services pursuant to
Sections 140.390 through 140.396;
19) Hospice services;
20) Nursing
care pursuant to Section 140.472;
21) Nursing
care for the purpose of transitioning children from a hospital to home
placement or other appropriate setting pursuant to 89 Ill. Adm. Code 146,
Subpart D;
22) Telehealth services pursuant to Section 140.403;
23) Preventive
services;
24) Licensed
Clinical Social Worker services;
25) Licensed
Clinical Psychologist services;
26) Effective
January 1, 2018, abortion services; and
27) Effective
January 1, 2022, coverage of routine patient cost for items and services in
connection with participation in a qualified clinical trial, as defined in
Section 1905(gg) of the Social Security Act.
c) Effective July 1, 2012, the following medical services shall
be covered for recipients age 21 or over who are included under subsection (a):
1) Inpatient hospital services;
2) Hospital outpatient and clinic services;
3) Hospital emergency room visits. The visit must be for the
alleviation of severe pain or for immediate diagnosis and/or treatment of
conditions or injuries that might result in disability or death if there is not
immediate treatment;
4) Encounter rate clinic visits;
5) Physician services;
6) Pharmacy services;
7) Home health agency visits;
8) Laboratory and x-ray services;
9) Group care services;
10) Family planning services and supplies;
11) Medical
supplies, equipment, prostheses and orthoses, and respiratory equipment and
supplies;
12) Transportation
to secure medical services;
13) Subacute
alcoholism and substance abuse services pursuant to Sections 140.390 through
140.396;
14) Hospice
services;
15) Dental
services, pursuant to Section 140.420;
16) Pod
ervices and supplies;
11) Medical
supplies, equipment, prostheses and orthoses, and respiratory equipment and
supplies;
12) Transportation
to secure medical services;
13) Subacute
alcoholism and substance abuse services pursuant to Sections 140.390 through
140.396;
14) Hospice
services;
15) Dental
services, pursuant to Section 140.420;
16) Podiatric
services, pursuant to Section 140.425 for individuals with a diagnosis of
diabetes;
17) Optical services and supplies;
18) Telehealth
services pursuant to Section 140.403;
19) Preventive services;
20) Licensed Clinical
Social Worker services;
21) Licensed Clinical
Psychologist services;
22) Effective January 1,
2018, abortion services; and
23) Effective
January 1, 2022, coverage of routine patient cost for items and services in
connection with participation in a qualified clinical trial, as defined in
Section 1905(gg) of the Social Security Act.
This is a copy of a public record, reproduced as it was published. It is not legal advice, and it may not be the version a court would rely on. Check the official source before you cite it.