Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 140 - MEDICAL PAYMENT
Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES
Section 140.478 - Prior Approval for Medical Equipment, Supplies, Prosthetic Devices and Orthotic Devices
Universal Citation: 89 IL Admin Code ยง 140.478
Current through Register Vol. 48, No. 38, September 20, 2024
a) The following time frames shall be adhered to by the Department when prior approval is required for medical equipment, prosthetic devices and orthotic devices (see also Section 140.40 ):
1) Decisions to approve or deny a request
for prior approval of life-sustaining respiratory supplies and equipment will
be made within 30 days after the date of receipt of the request by the
Department. Prior approval is not required for such items for the first 30 days
of service.
2) Decisions to approve
or deny requests for artificial limbs and braces shall be made within 21 days
after the date of receipt of the request by the Department.
3) Decisions to approve or deny requests for
standard wheelchairs and hospital beds shall be made within 21 days after the
date of receipt of the request by the Department.
4) Decisions to approve or deny requests for
hearing aids, communication devices, custom molded shoes, shoe corrections,
orthopedic shoes used in conjunction with a brace, and custom wheelchairs,
shall be made within 30 days after the date of receipt of the request by the
Department.
5) Decisions to approve
or deny requests for medical supplies costing less than $100 shall be made
within 21 days after the date of receipt of the requests by the
Department.
6) Decisions to approve
or deny requests for medical supplies costing more than $100 shall be made
within 30 days after the date of receipt of the request by the
Department.
b) Post approval may be requested. Post approval will be granted in circumstances when prior approval could not be requested, such as:
1) determination of the patient's eligibility
for public assistance was delayed;
2) the medical need arose unexpectedly
outside of the Department's normal business hours and prior approval could not
be obtained;
3) other third party
resources denied payment.
Disclaimer: These regulations may not be the most recent version. Illinois may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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