TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.991 PRIMARY CARE PROVIDER PARTICIPATION REQUIREMENTS


 

Section 140.991  Primary Care Provider Participation Requirements

 

a)         Providers eligible to be Primary Care Providers (PCPs) are physicians, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), school-based/linked clinics, certified local health departments, hospital clinics per Section 140.461(f), and Encounter Rate Clinics (ERCs) per Section 140.461(b).

 

b)         PCPs shall meet the qualifications (see Section 140.12) that are applicable for all medical providers under the Illinois Medical Assistance Program.

 

c)         PCPs shall:

 

1)         Establish and maintain hospital admitting and/or delivery privileges or arrangements for admission to a nearby hospital;

 

2)         Complete, sign, and comply with terms of the Department's Primary Care Provider Agreement;

 

3)         Provide to the patients enrolled with them under the PCCM program:

 

A)        Periodic health screening (EPSDT), including age appropriate immunizations, and primary pediatric care as needed for children served in their practice;

 

B)        Obstetrical care and delivery services as appropriate for pregnant women within the scope of their practice;

 

C)        Provide risk assessments for pregnant women and/or children;

 

D)        Provide medical care coordination, including arranging for diagnostic consultation and specialty care and communicating with the case management entity;

 

E)        Maintain 24-hour telephone coverage for assessment and consultation.

 

(Source:  Added at 31 Ill. Reg. 388, effective December 29, 2006)