(305 ILCS 5/5-18) (from Ch. 23, par. 5-18)
Sec. 5-18.
(Repealed).
(Source: P.A. 87-895. Repealed by P.A. 92-275, eff. 8-7-01.)
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(305 ILCS 5/5-18.5) Sec. 5-18.5. Perinatal doula and evidence-based home visiting services. (a) As used in this Section: "Home visiting" means a voluntary, evidence-based strategy used to support pregnant people, infants, and young children and their caregivers to promote infant, child, and maternal health, to foster educational development and school readiness, and to help prevent child abuse and neglect. Home visitors are trained professionals whose visits and activities focus on promoting strong parent-child attachment to foster healthy child development. "Perinatal doula" means a trained provider who provides regular, voluntary physical, emotional, and educational support, but not medical or midwife care, to pregnant and birthing persons before, during, and after childbirth, otherwise known as the perinatal period. "Perinatal doula training" means any doula training that focuses on providing support throughout the prenatal, labor and delivery, or postpartum period, and reflects the type of doula care that the doula seeks to provide. (b) Notwithstanding any other provision of this Article, perinatal doula services and evidence-based home visiting services shall be covered under the medical assistance program, subject to appropriation, for persons who are otherwise eligible for medical assistance under this Article. Perinatal doula services include regular visits beginning in the prenatal period and continuing into the postnatal period, inclusive of continuous support during labor and delivery, that support healthy pregnancies and positive birth outcomes. Perinatal doula services may be embedded in an existing program, such as evidence-based home visiting. Perinatal doula services provided during the prenatal period may be provided weekly, services provided during the labor and delivery period may be provided for the entire duration of labor and the time immediately following birth, and services provided during the postpartum period may be provided up to 12 months postpartum. (b-5) Notwithstanding any other provision of this Article, beginning January 1, 2023, licensed certified professional midwife services shall be covered under the medical assistance program, subject to appropriation, for persons who are otherwise eligible for medical assistance under this Article. The Department shall consult with midwives on reimbursement rates for midwifery services. (c) The Department of Healthcare and Family Services shall adopt rules to administer this Section. In this rulemaking, the Department shall consider the expertise of and consult with doula program experts, doula training providers, practicing doulas, and home visiting experts, along with State agencies implementing perinatal doula services and relevant bodies under the Illinois Early Learning Council. This body of experts shall inform the Department on the credentials necessary for perinatal doula and home visiting services to be eligible for Medicaid reimbursement and the rate of reimbursement for home visiting and perinatal doula services in the prenatal, labor and delivery, and postpartum periods. Every 2 years, the Department shall assess the rates of reimbursement for perinatal doula and home visiting services and adjust rates accordingly. (d) The Department shall seek such State plan amendments or waivers as may be necessary to implement this Section and shall secure federal financial participation for expenditures made by the Department in accordance with this Section.
(Source: P.A. 102-4, eff. 4-27-21; 102-1037, eff. 6-2-22.) |
(305 ILCS 5/5-18.10) Sec. 5-18.10. Reimbursement for postpartum visits. (a) In this Section: "Certified lactation counselor" means a health care professional in lactation counseling who has demonstrated the necessary skills, knowledge, and attitudes to provide clinical breastfeeding counseling and management support to families who are thinking about breastfeeding or who have questions or problems during the course of breastfeeding. "Certified nurse midwife" means a person who exceeds the competencies for a midwife contained in the Essential Competencies for Midwifery Practice, published by the International Confederation of Midwives, and who qualifies as an advanced practice registered nurse. "Community health worker" means a frontline public health worker who is a trusted member or has an unusually close understanding of the community served. This trusting relationship enables the community health worker to serve as a liaison, link, and intermediary between health and social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. "International board-certified lactation consultant" means a health care professional who is certified by the International Board of Lactation Consultant Examiners and specializes in the clinical management of breastfeeding. "Medical caseworker" means a health care professional who assists in the planning, coordination, monitoring, and evaluation of medical services for a patient with emphasis on quality of care, continuity of services, and affordability. "Perinatal doula" means a trained provider of regular and voluntary physical, emotional, and educational support, but not medical or midwife care, to pregnant and birthing persons before, during, and after childbirth, otherwise known as the perinatal period. "Public health nurse" means a registered nurse who promotes and protects the health of populations using knowledge from nursing, social, and public health sciences. (b) The Illinois Department shall establish a medical assistance program to cover a universal postpartum visit within the first 3 weeks after childbirth and a comprehensive visit within 4 to 12 weeks postpartum for persons who are otherwise eligible for medical assistance under this Article. In addition, postpartum care services rendered by perinatal doulas, certified lactation counselors, international board-certified lactation consultants, public health nurses, certified nurse midwives, community health workers, and medical caseworkers shall be covered under the medical assistance program.
(Source: P.A. 102-665, eff. 10-8-21.) |
(305 ILCS 5/5-19) (from Ch. 23, par. 5-19)
Sec. 5-19. Healthy Kids Program.
(a) Any child under the age of 21 eligible to receive Medical Assistance
from the Illinois Department under Article V of this Code shall be eligible
for Early and Periodic Screening, Diagnosis and Treatment services provided
by the Healthy Kids Program of the Illinois Department under the Social
Security Act, 42 U.S.C. 1396d(r).
(b) Enrollment of Children in Medicaid. The Illinois Department shall
provide for receipt and initial processing of applications for Medical
Assistance for all pregnant women and children under the age of 21 at
locations in addition to those used for processing applications for cash
assistance, including disproportionate share hospitals, federally qualified
health centers and other sites as selected by the Illinois Department.
(c) Healthy Kids Examinations. The Illinois Department shall consider
any examination of a child eligible for the Healthy Kids services provided
by a medical provider meeting the requirements and complying with the rules
and regulations of the Illinois Department to be reimbursed as a Healthy
Kids examination.
(d) Medical Screening Examinations.
(1) The Illinois Department shall insure Medicaid | ||
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(2) The Illinois Department shall pay for an | ||
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(A) requested by a child's parent, guardian, or | ||
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(B) necessary for enrollment in school; or
(C) necessary for enrollment in a licensed day | ||
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(D) necessary for placement in a licensed child | ||
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(E) necessary for attendance at a camping | ||
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(F) necessary for participation in an organized | ||
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(G) necessary for enrollment in an early | ||
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(H) necessary for participation in a Women, | ||
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(I) deemed appropriate by the Illinois Department.
(e) Minimum Screening Protocols For Periodic Health Screening
Examinations. Health Screening Examinations must include the following
services:
(1) Comprehensive Health and Development Assessment | ||
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(A) Development/Mental Health/Psychosocial | ||
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(B) Assessment of nutritional status including | ||
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(2) Comprehensive unclothed physical exam;
(3) Appropriate immunizations at a minimum, as | ||
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(4) Appropriate laboratory tests including blood lead | ||
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(A) Anemia test.
(B) Sickle cell test.
(C) Tuberculin test at 12 months of age and every | ||
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(D) Other -- The Illinois Department shall insure | ||
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(5) Health Education. The Illinois Department shall | ||
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(6) Vision Screening. The Illinois Department shall | ||
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(7) Hearing Screening. The Illinois Department shall | ||
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(8) Dental Screening. The Illinois Department shall | ||
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(f) Covered Medical Services. The Illinois Department shall provide
coverage for all necessary health care, diagnostic services, treatment and
other measures to correct or ameliorate defects, physical and mental
illnesses, and conditions whether discovered by the screening services or
not for all children eligible for Medical Assistance under Article V of
this Code.
(g) Notice of Healthy Kids Services.
(1) The Illinois Department shall inform any child | ||
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(2) The Illinois Department shall widely disseminate | ||
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(3) The Illinois Department shall utilize accepted | ||
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(4) The Illinois Department shall provide notice of | ||
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(A) orally by the intake worker and in writing at | ||
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(B) at the time the applicant is informed that he | ||
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(C) at least 20 days before the date of any | ||
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(h) Data Collection. The Illinois Department shall collect data in a
usable form to track utilization of Healthy Kids screening examinations by
children eligible for Healthy Kids services, including but not limited to
data showing screening examinations and immunizations received, a summary
of follow-up treatment received by children eligible for Healthy Kids
services and the number of children receiving dental, hearing and vision
services.
(i) On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e. (j) To ensure full access to the benefits set forth in this
Section, on and after January 1, 2022, the Illinois Department
shall ensure that provider and hospital reimbursements for
immunization as required under this Section are no lower than
70% of the median regional maximum administration fee for the State of Illinois as established
by the U.S. Department of Health and Human Services' Centers
for Medicare and Medicaid Services. (Source: P.A. 102-43, eff. 7-6-21.)
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(305 ILCS 5/5-20)
Sec. 5-20. Electronic health care card. By December 31, 1994, the
Illinois Department may develop and implement by rule an electronic health
information system to process claims electronically and to electronically store
Medicare and Medicaid patient records, medical histories, and billing
information. The Illinois Department may issue each Medicare and Medicaid
recipient a health card containing electronically coded information that will
access the system, verify their Medicare or Medicaid status, and display how
much the patient must pay in deductibles or copayments for a medical procedure.
The Illinois Department may also develop safeguards to protect recipients'
health information from misuse or unauthorized disclosure.
On or before July 1, 2011, the Department shall cease issuing monthly MediPlan cards and shall instead issue permanent or semi-permanent member cards to individuals enrolled for medical assistance. Furthermore, the Department may employ any reasonable means by which providers may verify an individual's eligibility for medical assistance in place of MediPlan cards. (Source: P.A. 96-940, eff. 1-1-11.)
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(305 ILCS 5/5-21)
Sec. 5-21. Immunization. By July 1, 1994, the Illinois Department shall,
in cooperation with the Department of Public Health, establish and implement a
pilot program that will provide immunization services for children on a walk-in
basis at local public aid offices. The Director shall determine the number and
location of the local public aid offices that will participate in the pilot
program. The Illinois Department shall submit a report on the effectiveness
of the program to the General Assembly on or before December 31, 1995.
The Department of Healthcare and Family Services (formerly Department of Public Aid) and the Department of Human Services, in
cooperation with the Department of Public Health, shall continue to implement
the pilot program after the effective date of this amendatory Act of 1996.
(Source: P.A. 95-331, eff. 8-21-07.)
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(305 ILCS 5/5-22)
Sec. 5-22. (Repealed).
(Source: P.A. 90-655, eff. 7-30-98. Repealed by P.A. 96-1123, eff. 1-1-11.)
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(305 ILCS 5/5-23)
Sec. 5-23.
(Repealed).
(Source: P.A. 92-581, eff. 6-26-02. Repealed internally, eff. 7-1-03.)
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(305 ILCS 5/5-24)
Sec. 5-24. (Repealed). (Source: P.A. 97-689, eff. 6-14-12. Repealed internally, eff. 1-1-14.)
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(305 ILCS 5/5-25) Sec. 5-25. Pediatric asthma initiative. (a) During fiscal year 2006, the Department of Public Aid shall evaluate current standards of treatment of asthma for its beneficiaries. The review may include state-of-the-art programs in asthma disease management as well as evidence-based best practices for the early diagnosis, treatment, and control of asthma, particularly in children. The Department's review may include asthma disease management as one component of a comprehensive disease management model. The Department shall consult with the Department of Public Health and other State agencies, advocates, and providers in conducting this review. The Department's review shall also seek to maximize collaborations between existing asthma programs in the State of Illinois. The review shall also assess the available methods of implementing and funding asthma disease management and treatment within the Medicaid program. (b) After completing the review under subsection (a), the Department of Public Aid shall develop a pilot asthma disease management program. The pilot program shall be targeted to an area or areas with the highest prevalence of asthma.
The Department shall consult with the Department of Public Health and other State agencies, federal health agencies, experts in asthma and immunology, providers, and consumers in developing the pilot program. The pilot program shall also seek to maximize collaborations between existing asthma programs in the State of Illinois. The pilot program shall be subject to specific appropriations or budget savings derived from the program due to reduced asthma-related hospitalizations or emergency room visits.
(Source: P.A. 94-328, eff. 7-26-05.) |
(305 ILCS 5/5-26) Sec. 5-26. Federal Family Opportunity Act. (a) As used in this Section, "the federal Act" means the federal Family Opportunity Act, enacted as part of the Deficit Reduction Act of 2005.
(b) Subject to appropriations for program administration and services, the Department of Human Services, in conjunction with the Department of Healthcare and Family Services, shall implement the Medical Assistance provisions of the federal Act as soon as possible after the effective date of this amendatory Act of the 95th General Assembly. (c) As soon as possible after the effective date of this amendatory Act of the 95th General Assembly, the Department of Human Services, in conjunction with the Department of Healthcare and Family Services, shall take all necessary and appropriate steps to try to secure (i) any available federal funds for a demonstration project regarding home and community-based alternatives to psychiatric residential treatment facilities for children, as authorized by the federal Act, and (ii) the location in Illinois of a family-to-family health information center, as authorized by the federal Act.
(Source: P.A. 97-48, eff. 6-28-11.) |