Ill. Admin. Code tit. 89, § 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
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;
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;
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 .
Notes
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