Section 140.10  Medical Assistance Provided to Incarcerated Persons

a)         The Department shall pay for medical services provided to persons incarcerated in county jails pending trial, who at the time of arrest had laready been determined eligible for medical assistance under the AFDC, AABD, MANG, AMI, or Ga (Chicago) programs, subject to the following conditions:

1)         The county or arresting authority (a unit of local government other than a county which employs peace officers who have made the arrest of a person) is responsible for the first $2,500 in medical services provided the incarcerated person;

2)         The Department will pay only for medical services in excess of $2,500 covered by the specific medical assistance program for which the incarcerated person was determined eligible;

3)         Payment will be at Department rates;

4)         The Department will pay only medical providers who are enrolled for participation in the Medical Assistance Program; and

5)         Medical assistance coverage under this rule shall terminate at the earlier of the date of the eprson's conviction or entry of a guilty plea or the date of the person's release from jail.

b)         Medical providers who seek payment from the Department for services provided to incarcerated persons shall first submit their claims on the appropriate billing forms to the County Sheriff or arresting authority equivalent.

c)         The County Sheriff or arresting authority equivalent will:

1)         Verify that the services billed correspond to the services rendered;

2)         Identify date of incarceration, date of conviction or guilty plea, and date of release, as appropriate, for the person receiving the medical services;

3)         Insure that all claims for payment, which pertain to an incident of health care provided to an incarcerated person, have been submitted; and

4)         Transmit all claims pertaining to a health care incident in a group to the Department.

d)         The Department will adjudicate each group of claims and notify the County Sheriff or arresting authority equivalent and the medical providers of its disposition of the claims.

(Source:  Amended at 12 Ill. Reg. 7695, effective April 21, 1988)