TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.994 PANEL SIZE AND AFFILIATED PROVIDERS


 

Section 140.994  Panel Size and Affiliated Providers

 

a)         PCPs may designate to the Department those providers who provide primary care coverage for the PCP's patients when the PCP is unavailable.  Providers so designated will not need a referral in order to be reimbursed by the Department for services provided to that PCP's patients.

 

b)         The Department shall limit the number of patients enrolled with a PCP to 1,800.  A PCP practicing with an Advanced Practice Nurse (APN), Physician's Assistant (PA) or Resident may have his or her panel size increased by 900 patients for each Full Time Equivalent APN, PA or Resident in his or her practice.  The limit on the number of patients enrolled with a clinic that is allowed to enroll as a PCP shall be based on the number of Full Time Equivalent physicians, APNs or PAs within the site.

 

c)         A PCP may limit his or her panel to a specified number of patients less than the maximum number set forth in this Section, may limit that panel to only his or her existing patients or existing patients and their family members, and may limit patients by age or other factors relevant to the scope of his or her practice.

 

d)         In areas where there is an insufficient number of PCPs to adequately serve the population eligible to enroll in the PCCM program without exceeding the panel limits established in subsection (b), the Department may allow APNs to enroll as PCPs or allow PCPs to exceed the limit established in subsection (b) of this Section.

 

e)         A PCP may decline to have patients auto-assigned to him or her who have not chosen that PCP.

 

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