Section 140.458  Prior Approval for Therapy Services

a)         Effective July 1, 2012 through September 30, 2014, prior approval is required for the provision of services by an independent speech/language, physical or occupational therapist or by a community health agency, unless:

1)         the individual is eligible for services under Medicare; or

2)         the individual is under the age of 21.

b)         Effective October 1, 2014, prior approval shall be required for all individuals, except for individuals eligible for services under Medicare and except when the individual is under age 21 and the date of service is prior to July 1, 2015.

c)         Approval will be granted when, in the judgment of a consulting physician and/or professional staff of the Department, the services are medically necessary and appropriate to meet the individual's medical needs.

d)         The decision to approve or deny a request for prior approval will be made within 21 days after the date the request and all necessary information is received.

(Source:  Amended at 38 Ill. Reg. 23623, effective December 2, 2014)