Ill. Admin. Code tit. 89, pt. 140, subpt. L, tbl. E
ITEM/SERVICE | NUMBER OF DAYS |
1. Routine transportation within Illinois or to facilities normally utilized by Illinois residents | 10 |
2 Supplies/sickroom needs costing less than $100 | 21 |
3. Standard wheel chairs | 21 |
4. Standard hospital beds | 21 |
5. Specialty-equipped hospital beds | 21 |
6. Custom wheel chairs | 30 |
7. Respiratory equipment | 30 |
8. Other durable equipment | 30 |
9. Braces, artificial limbs and other prosthetic devices | 21 |
10. Custom-built shoes and shoes to which a brace or other corrective device is attached. | 30 |
11. Hearing aids | 30 |
12. In-patient hospital physical rehabilitation services | 30 |
13. Supplies/sickroom needs over $100 | 30 |
14. Transportation to remote facilities outside Illinois and extra-ordinary modes of transportation | 21 |
15. Physical therapy | 30 |
16. Speech therapy | 30 |
17. Occupational therapy | 30 |
18. Home Health Agency | 21 |
19. Intermittent services in the home by a registered nurse | 21 |
20. Private duty registered nurse service in a hospital | 10 |
21. Dental Services | 30 |
22. Dental Services for GA/AMI/Refugee Programs | 30 |
23. Eye Care Services | 30 |
24. Chiropractic Services | 30 |
25. Podiatric Services | 30 |
26. All other items or services requiring prior approval. | 30 |
Ill. Admin. Code tit. 89, pt. 140, subpt. L, tbl. E