Section 140.479  Limitations, Medical Supplies

a)         Reimbursement for medical supplies will be limited to the quantity indicated by the ordering practitioner or to the quantity specified in the Department's prior approval, whichever is less.  Once the total quantity specified by the ordering practitioner has been provided or the period of time shown on the approval request has elapsed, a new written order must be obtained.

b)         A new written order must be obtained from the physician no less often than every 12 months, even for supplies needed for an ongoing chronic condition.

c)         Prior approval for the purchase of medical supplies is required except when:

1)         The client is a Medicare beneficiary and the item requested has been reimbursed under the Medicare program; or

2)         Items are being dispensed, per physician order, in amounts less than the normal maximum allowable quantity limits established by the Department.

d)         The exemptions from prior approval specified in subsection (c) apply only if the quantity ordered by the physician is equal to or less than the Department's maximum allowable quantity.  If the physician has ordered a quantity that exceeds the Department's maximum allowable quantity, the dispensing provider must request prior approval for the entire order.  The Department will not pay for the dispensing of any quantity that is less than the physician's order, unless:

1)         the dispensing provider can document that the ordering physician has confirmed that the excess quantity is not medically necessary; or

2)         the Department has denied the request for prior approval of the excess quantity.

(Source:  Amended at 25 Ill. Reg. 12820, effective October 8, 2001)