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
|
(Source: Added (by codification with no substantive change) at 8 Ill.
Reg. 17899)