Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart L - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Table H - Areas of Major Life Activity

Current through Register Vol. 48, No. 28, July 12, 2024
The Individual Is
Eligible for ICF/MR Services
The Individual Is Not
Eligible for ICF/MR Services
SELF CARE
The ability to perform daily activities to
							 meet basic life needs including feeding, bathing, toileting, dressing, and
							 hygiene and grooming.
Eligible:
Not Eligible:
The individual fees (using knife and
							 fork), bathes, and dresses self; combs/brushes hair; may need occasional
							 reminders to initiate activities and follow through on components of tasks or
							 recall performance methods; toilets independently; may shampoo and roll up/set
							 hair; may wash and/or iron and store clothing.
The individual exercise self care in
							 personal hygiene and grooming, feeding, bathing dressing, and toileting; may
							 need health care or personal care reminders; may need assistance in selecting
							 or purchasing clothing.
LANGUAGE
Communication involving verbalization or
							 an alternative communication system which enables an individual to convey ideas
							 and information to others (expressive), and understand communication from
							 others (receptive).
Eligible:
Not Eligible:
The individual can describe or state basin
							 needs or concerns in concrete phrases and sentences to interact in simple
							 conversation; can answer questions about basic or simple needs or concerns; may
							 use "because" or "but"; is able to express self (verbally or with an
							 alternative system) and be understood by someone who does not know the
							 individual but does know the communication system; may recognize words
The individual communicates complete
							 verbal concepts and understands them; carries on everyday conversations, but
							 cannot discuss abstract or philosophical concepts; typically can use a
							 telephone; may communicate in writing in simple letter or orders; does not
							 write/communicate about theoretical ideas or important current events.
LEARNING
General cognitive competence; the ability
							 to acquire new behaviors, perceptions and information; and the ability to apply
							 experiences to new situations.
Eligible:
Not Eligible:
The individual obtains a score in the
							 moderate to severe/profound range of intellectual functioning as measured by a
							 standardized full scale, assessment on an individual intelligence test, such as
							 a score of 54 or below on the WAIS-R
The individual obtains a score in the mild
							 range of intellectual functioning as measured by standardized full scale,
							 assessment on an individual intelligence test, such as a score of 55 or above
							 on the WAIS-R
MOBILITY
The ability to perform gross- and
							 fine-motor skills. The capability of locomotion, either by independent
							 ambulation or with mobility assistance such as adaptive equipment/mechanical
							 aids.
Eligible:
Not Eligible:
The individual exhibits good body control;
							 can alternate feet to climb stairs; has good gross-and fine-motor skills
							 coordination such as being able to hit a target, throw a ball, run, hop, skip,
							 or jump (these skills are not required for eligibility); may independently
							 transfer into and out of wheelchair; lacks or has limited capacity to perform
							 activities requiring strength or coordination, such as dancing, cursive writing
							 or heavy lifting.
The individual is able to use hands (or
							 adaptive utensils) to care for self; goes about known areas with ease (i.e.
							 local neighborhood, campus or residence) via independent ambulation or
							 adaptive/supportive equipment (wheelchair, walker, cane); may use mass
							 transportation.
SELF DIRECTION
The management of, and control over, one's
							 personal and social life, by making decisions which affect and protect one's
							 self interests.
Eligible:
Not Eligible:
The individual may be conscientious about
							 assuming responsibility for simple tasks (household chores, assigned duties);
							 may ask of there is "work" to do; makes an effort to be dependable; attends to
							 a task well (15-20 minutes); may sometimes initiate his/her own
							 activities.
The individual initiates most of his/her
							 own activities; is conscientious about work (duties) and assumes much
							 responsibility; for tasks; requires guidance when activities/jobs necessitate
							 important decision making such as health care, care of others, and complicated
							 occupational activities.
CAPACITY FOR INDEPENDENT LIVING
The age appropriate ability to live
							 without extraordinary support.
Eligible:
Not Eligible:
The individual can be sent on everyday
							 errands such as to the store, supply or storage area for several items with
							 supervisory oversight; makes minor purchases; may add coins to total a dollar
							 or make change for a dollar; may do simple, routine household chores; prepares
							 simple foods that require mixing.
The individual cooks simple meals;
							 performs everyday household tasks (given the opportunity); engages in
							 semiskilled or simple skilled job not requiring complex thinking or judgement;
							 goes to several stores to purchase items; makes change, but may not be able to
							 use baking facilities; may have difficulty handling finances without guidance;
							 goes about local neighborhood or campus of residence with ease and without
							 supervisory oversight; independently recognizes emergency situations and takes
							 action (i.e. stops ongoing activity and exits a building in response to a fire
							 alarm).