Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 140 - MEDICAL PAYMENT
Subpart D - PAYMENT FOR NON-INSTITUTIONAL SERVICES
Section 140.487 - Healthy Kids Program Timeliness Standards

1) Description:

The Department shall inform eligible families in writing about the Healthy Kids Program, including: the importance of preventive health care; the services which are available; how to request assistance in identifying a willing and qualified provider or how to request assistance in obtaining transportation to and from health care appointments; and that the services are available at no cost to an eligible recipient, except as may be limited by a spenddown requirement.

2) Timeliness Standards:

1) Description:

Eligible persons shall be notified in writing of scheduled health, vision, hearing and dental screening periods.

2) Timeliness Standard:

The child or the caretaker relative (89 Ill. Adm. Code 101.20) shall receive notification of the next scheduled health, vision, hearing and dental screening periods not less than 10 working days before the date on which the screening period begins as determined by the child's birthday, the Periodicity Schedule and the most recent date of the child's eligibility for services.

1) Description:

A health, vision, hearing or dental screening shall be performed by a provider who is enrolled with the Illinois Medical Assistance Program.

2) Timeliness Standard:

A health, vision, hearing or dental screening shall occur, to the extent possible, during the next scheduled screening period as determined by the child's birthday, the most recent date of the child's eligibility and the periodicity schedules for screenings.

1) Description:

Diagnosis is the provider's assessment of a child's current state of health or disease.

2) Timeliness Standards:

1) Description:

When a provider determines that a child is in need of treatment for a condition discovered or determined to have increased in severity during a screening, the provider shall arrange to provide the needed treatment directly or shall refer the client for treatment. Referral for treatment shall include one or more of the following actions: informing the client (or client's caretaker) of the type of provider from whom treatment should be sought; or providing the client (or client's caretaker) with the name and address of a provider qualified to provide the needed treatment; or making an appointment for the client with a provider qualified to provide the needed treatment.

2) Upon request of an eligible person or notification by a qualified provider of an eligible person's need for referral assistance as the result of a screening, the Department shall refer the eligible person to a willing and qualified provider for treatment of a diagnosed or suspected condition, whether or not the treatment needed is a covered service. The eligible person shall be consulted about the referral, except when such consultation may jeopardize the health and safety of the child (e.g., cases of suspected child abuse or neglect). In making the referral, the Department shall first consider referral of the eligible person to other Federal and State-funded programs (e.g., services to crippled children and alcohol/drug abuse intervention) when such programs may be capable of treating or arranging treatment for the condition.

3) Timeliness Standard:

Referral, as defined above, shall be made within thirty (30) days of the request or identification of need, except that such referral shall be made immediately when the child is in imminent danger.

1) Description:

Treatment is the provision of health care needed to correct or ameliorate defects and physical and mental illnesses and conditions discovered or determined to have increased in severity by a qualified provider as the result of a screening.

2) Timeliness Standard:

Treatment consistent with recognized standards of medical or dental practice shall begin no more than sixty (60) days after the diagnosis of the child's condition, unless medically contraindicated, except that treatment shall begin sooner when the diagnosed condition requires it.

1) Description:

Upon oral or written request of a recipient, the Department shall provide assistance to identify a provider, to schedule an appointment with a provider or to arrange transportation to and from the source of medical or dental care.

2) Timeliness Standards:

1) Description:

The Department shall inform Medicaid-eligible pregnant women, postpartum women during the six (6) months after termination of their pregnancy, women up to one (1) year postpartum who are breastfeeding their infants and children below the age of five (5) years in writing of the availability of WIC Program benefits and procedures for accessing WIC services.

2) Timeliness Standards