§140.476. Medical Equipment, Supplies, Prosthetic Devices and Orthotic Devices for Which Payment Will Not Be Made

Payment shall not be made for:

 

a)         Items or repair of items for residents of long term care facilities, when such items are:

 

1)         Durable medical equipment or supplies required by an individual in a long term care facility that are commonly used in patient care and considered as a part of the per diem reimbursement paid by the Department.  Such items include, but are not limited to the following:  

 

A)        Equipment: Canes, crutches, standard wheelchairs, walkers, commodes, beds, mattresses, belts, cradles, trapeze bars, patient lifts, bedpans, urinals, suction equipment, supplies, hypothermia units, apnea monitors, and equipment necessary for the administration of oxygen.

 

B)        Supplies: Catheters, urinary drainage bags, first aid supplies, dressings, soaps, irrigation supplies, drinking tubes, and other supplies necessary to provide patient care.

 

2)         Equipment required for a resident of a long term care facility, unless the equipment must be made to order for an identified recipient and based on a medical need, or which is identified by the Individual Program Plan (IPP) of an individual with developmental disabilities as necessary to fulfill the requirements for active treatment services.

 

b)         Items or services that are not medically necessary to treat the recipient's disease, disability, infirmity or impairment.

 

c)         Prosthetic and orthotic devices inserted or implanted that do not increase physical capacity, overcome a handicap, restore a physiological function, or eliminate a functional disability.

 

d)         Items or services for which the Department has not granted prior approval where prior approval is required.

 

e)         Stock orthopedic shoes, unless used in conjunction with a brace.

 

f)         Items or services for a client who has elected hospice care, when the items or services are related to the terminal illness.

 

g)         Items or services fabricated, fitted or dispensed without an appropriate license.

 

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