Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES › Section 140.461 - Clinic Participation, Data and Certification Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Hospital-based
				organized clinics must:
1) Have an
				administrative structure, staff program, physical setting, and equipment to
				provide comprehensive medical care.
2) Agree to assume complete responsibility
				for diagnosis and treatment of the patients accepted by the clinic, or provide,
				at no additional cost to the Department, for the acquisition of these services
				through contractual arrangements with external medical providers.
3) Meet one of the following requirements:
A) Be adjacent to or on the premises of a
				hospital:
i) licensed under the Hospital
				Licensing Act or the University of Illinois Hospital Act; or
ii) that meets all comparable conditions and
				requirements of the Hospital Licensing Act in effect for the state in which it
				is located.
B) Have
				provider-based status under Medicare pursuant to
				42
				CFR 413.65.
C) Be clinically integrated as evidenced by
				all of the following:
i) Professional staff
				of the clinic have clinical privileges at the main hospital; the main hospital
				maintains the same monitoring and oversight of the clinic as it does for any
				other department of the hospital; medical staff committees or other
				professional committees at the main hospital are responsible for medical
				activities in the clinic, including quality assurance, utilization review, and
				the coordination and integration of services, to the extent practicable,
				between the clinic and the main hospital; medical records for patients treated
				in the clinic are integrated into a unified retrieval system of the main
				hospital, or cross reference that retrieval system; and inpatient and
				outpatient services of the clinic and the main hospital are integrated, and
				patients treated at the clinic who require further care have full access to all
				services of the main hospital and are referred when appropriate to the
				corresponding inpatient or outpatient department or service of the main
				hospital.
ii) Fully integrated
				within the financial system of the main hospital, as evidenced by shared income
				and expenses between the main hospital and the clinic.
iii) Held out to the public and other payers
				as part of the main hospital.
iv)
				Operated under the ownership and control of the main hospital, as evidenced by
				the following: the business enterprise that constitutes the clinic is 100
				percent owned by the main hospital; the main hospital and the clinic have the
				same governing body; the clinic is operated under the same organizational
				documents (e.g., bylaws and operating decisions) as the main hospital; and the
				main hospital has final responsibility for personnel policies (such as fringe
				benefits or code of conduct), and final approval for medical staff appointments
				in the clinic.
v) Located within a
				35 mile radius of the main hospital campus as defined in
				42
				CFR 413.65.
4) Meet the applicable requirements of 89
				Ill. Adm. Code
				148.40(d).