Section 140.474  Payment for Home Health Care Services

a)         Effective July 1, 2012, except for services described in subsection (b), home health agencies will be paid an all inclusive, per visit rate that shall be the lowest of the:

1)         Agency's usual and customary charge for the service;

2)         Agency's Medicare rate; or

3)         Department's maximum allowable rate of as identified in the Home Health Fee Schedule (see the Department's website).  Beginning with the State fiscal year 2002, the maximum allowable rate may be adjusted annually in consideration of the appropriation of funds by the General Assembly. 

b)         Payment to self-employed registered nurses providing in-home nursing services is made at the community rate for those services as determined for each case at the time prior approval is given. 

c)         Payment for in-home shift nursing for children who are under 21 years of age under Section 140.472(b) shall be at the Department's established hourly rate to an agency licensed to provide these services.  The hourly rate for in-home shift nursing care may be adjusted in consideration of the appropriation of funds by the General Assembly.

d)         Payment for medical equipment and supplies will be made in accordance with Section 140.481.

(Source:  Amended at 42 Ill. Reg. 4829, effective March 1, 2018)