CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.3 COVERED SERVICES UNDER MEDICAL ASSISTANCE PROGRAMS
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 programs;
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) recipients eligible under the State Transitional Assistance Program who are determined by the Department to be disabled; and
7) Individuals 19 years of age or older eligible under the KidCare Parent
Coverage Waiver as described at 89 Ill. Adm. Code 120.32 except for:
A) Services provided only through a waiver approved under section
1915(c) of the Social Security Act; and
B) Termination of pregnancy.
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 which 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; and
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.
c) 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 which 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;
16) Chiropractic services;
17) Podiatric services; and
18) Optical services and supplies.
(Source: Amended at 29 Ill. Reg. 14957, effective September 30, 2005)