Section 140.920  General Description

a)         The Maternal and Child Health Program is a primary health care program coupled with case management services for Medicaid enrolled pregnant women and children.  The program is designed to ensure access to quality health care services.

b)         Case Management Component

The Maternal and Child Health Program shall include a case management component which shall be in place statewide.  Under the case management component, pregnant women and infants under the age of 12 months will be provided with case management services, as described in Section 140.922(c), by a community-based case management agency that will be responsible for assisting the client in accessing health care and support services necessary to comply with their physicians' recommendations.  Such case management services will be provided through age five years for DCFS wards.

c)         The Maternal and Child Health Program is designed to increase provider participation through special incentives for providers for certain services provided to pregnant women and children under age 21.  These include increased payment rates for selected services, as described in Section 140.930, and expedited payment.  To participate in the program, providers must meet specific participation requirements, as described in Section 140.924, and sign a Maternal and Child Health provider agreement, in addition to being enrolled as a Medicaid Provider. Under the Maternal and Child Health Program the Department agrees to:

1)         Pay enhanced rates for prenatal risk assessment, which includes substance abuse information,

2)         Pay enhanced rates for delivery services,

3)         Pay enhanced rates for primary care office visits and screening services provided to children,

4)         Provide prospective payment or expedited processing of claims for physicians who request special processing,

5)         Upon request of medical providers, furnish client eligibility and profiles of prior services reimbursed by the Department,

6)         Facilitate access to medical care for clients in cooperation with the physician and case management entity.

d)         Those clinics which were enrolled under the Healthy Moms/Healthy Kids Program shall be deemed certified in the Maternal and Child Health Program.

e)         Those providers enrolled under the Healthy Moms/Healthy Kids Program shall be deemed certified in the Maternal and Child Health Program.

(Source:  Amended at 20 Ill. Reg. 4345, effective March 4, 1996)