Ill. Admin. Code tit. 89, § 140.477 - Limitations on Equipment, Prosthetic Devices and Orthotic Devices

a) Effective July 1, 2012, prior approval for the purchase, repair or rental of certain medical equipment, prosthetic devices and orthotic devices is required except when:

1) The client is a Medicare beneficiary and the item requested has been reimbursed under the Medicare program; or

2) The item is being loaned pending repair or replacement of the recipient's own item.

b) Replacement of covered equipment, prosthetic devices and orthotic devices is subject to all policies that apply to an original purchase of the same item. Replacements will not be reimbursed by the Department if the original item is under a warranty that would cover the necessary repairs or replacement. If the item requires prior approval and if the item was purchased by the Department for the same client within the past 12 months, the Department's original determination of medical necessity will be deemed adequate for the replacement purchase. In this case, the request for prior approval must contain an explanation of the need for replacement. The Department may deny payment for replacement of equipment if evidence indicates that breakage or loss has resulted from abuse of the equipment.

Notes

Ill. Admin. Code tit. 89, § 140.477

Amended at 37 Ill. Reg. 10282, effective June 27, 2013