TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.992 POPULATIONS ELIGIBLE TO PARTICIPATE IN THE PRIMARY CARE CASE MANAGEMENT PROGRAM


 

Section 140.992  Populations Eligible to Participate in the Primary Care Case Management Program

 

a)         Individuals enrolled in programs administered by the Department under Article V of the Public Aid Code, the Children's Health Insurance Program Act, the Covering ALL KIDS Health Insurance Act, or the Veterans' Health Insurance Program Act and not excluded by subsection (b) or (c) of this Section are eligible to participate in the Primary Care Case Management (PCCM) program.

 

b)         Excluded populations are:

 

1)         Individuals covered by Medicare;

 

2)         Children under age 21 receiving Supplemental Security Income (SSI);

 

3)         Department of Children and Family Services (DCFS) wards and individuals participating in the Subsidized Guardianship or Adoption Assistance programs;

 

4)         Children under age 21 covered under the Aid to the Aged, Blind and Disabled (AABD) program;

 

5)         Residents of nursing facilities;

 

6)         American Indian/Alaska natives;

 

7)         Spend-down individuals;

 

8)         Persons enrolled in the following Home and Community Based Services (HCBS) Waiver Programs:

 

A)        Adults with developmental disabilities (DD);

 

B)        Residential waiver for children and young adults with DD;

 

C)        Support waiver for children and young adults with DD;

 

D)        Persons with brain injury;

 

E)        Persons with HIV or AIDS;

 

F)         Supportive living facilities;

 

G)        Persons who are elderly (age 60-64); and

 

H)        Children who are medically fragile/technology dependent;

 

9)         Individuals in community integrated living arrangements (CILAs);

 

10)         Individuals in presumptive eligibility programs;

 

11)         Refugees;

 

12)         Children, under the age of 21, who are receiving services through a family-centered, community based, coordinated care system that receives grant funds under Section 501(a)(1)(D) of Title V of the Social Security Act or whose care is otherwise managed by the Division of Specialized Care for Children of the University of Illinois at Chicago or the Department;

 

13)         Individuals enrolled in the following programs with limited benefits:

 

            A)        Illinois Healthy Women;

 

            B)        All Kids Rebate and FamilyCare Rebate;

 

            C)        Illinois Cares Rx;

 

            D)        Transitional Assistance, age 19 or older;

 

            E)        Emergency Medical Only;

 

            F)         Hospice; and

 

G)        Sexual Assault, Renal, and Hemophilia programs.

 

c)         Populations already managed are:

 

1)         Individuals with high level Third Party Liability (TPL) private insurance; and

 

2)         Individuals in the Program for All-Inclusive Care for the Elderly (PACE) participants.

 

(Source:  Amended at 34 Ill. Reg. 516, effective January 1, 2010)