Ill. Admin. Code tit. 89, § 140.473 - Prior Approval for Home Health Care Services
a) Prior approval is required for the
provision of home health services described in Section
140.472.
The decision to approve or deny a request for prior approval will be made
within 21 days after the date the request is received or within 21 days after
receipt of additional information, whichever occurs later. Prior approval is
also required for participants needing more than one skilled nursing visit per
day.
b) Prior approval is required
for the provision of all home health services to terminally ill participants
covered under the Transitional Assistance Program and the Family and Children
Assistance Program.
c) Effective
July 1, 2012, prior approval is not required for intermittent skilled nursing
services provided by a home health agency provider for participants within the
first 60 days after discharge from an acute care or rehabilitation hospital
when services are initiated within 14 days after discharge.
d) Prior approval is required for all in-home
shift nursing for individuals who are under 21 years of age or who receive
services under the Illinois Home and Community-Based Services Waiver for
Persons who are Medically Fragile, Technology Dependent (MFTD Waiver). The
decision to approve or deny a request for prior approval will be made within 21
days after the date the request is received or within 21 days after receipt of
additional information, whichever occurs later. Review of services for
individuals eligible for in-home shift nursing under the MFTD Waiver will be
made in accordance with 89 Ill. Adm. Code
120.530.
e) Approval will be granted when, in the
judgment of a consulting physician and subject to the review of the
professional staff of the Department, the services are medically necessary and
appropriate to meet the participant's medical needs.
f) Medical equipment and supplies are subject
to the prior approval requirements outlined in Sections
140.40
and
140.478.
Documentation of the face-to-face encounter described in Section
140.475(g)
must be submitted with the prior approval.
Notes
Amended at 37 Ill. Reg. 10282, effective June 27, 2013
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