TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.996 ACCESS TO HEALTH CARE SERVICES


 

Section 140.996  Access to Health Care Services

 

a)         With the exception of those direct access services identified in subsection (b), individuals enrolled with a PCP may only access health care services from that PCP, or a provider designated to the Department as affiliated with that PCP, or a provider to whom that PCP has referred those individuals.

 

b)         Individuals enrolled with a PCP do not need a referral in order to access the services determined to be direct access by the Department.  These services include:

 

1)         Services provided to newborns up to 91 days after birth

 

2)         Family Planning and Obstetrical and Gynecological (OB/Gyn) Services

 

3)         Inpatient and Outpatient Hospital Services

 

4)         Shots/Immunizations

 

5)         Emergency Services

 

6)         Emergency and Non-Emergency Transportation

 

7)         Pharmaceuticals

 

8)         Dental Services

 

9)         Vision Services

 

10)         Therapies

 

11)         Mental Health and Substance Abuse Services

 

12)         Outpatient Ancillary Services (radiology, pathology, lab, anesthesia)

 

13)         Services to Treat Sexually Transmitted Diseases and Tuberculosis

 

14)         Early Intervention Services

 

15)         Lead Screening and Epidemiological Services

 

16)         Services provided in the following settings:

 

A)        School-Based/Linked Clinics for Children under Age 21

 

B)        School-Based Clinics through Local Education Authorities for Children under Age 21

 

C)        Local Health Departments

 

D)        Mobile Vans, with Department approval

 

E)        FQHC Homeless Sites and Migrant Health Centers.

 

(Source:  Added at 31 Ill. Reg. 6930, effective April 29, 2007)