Section 140.930  Reimbursement

a)         Reimbursement Rates for Maternal and Child Health Providers

1)         Participating FQHC, as described in Section 140.461(d), that meet the criteria specified in 140.924(a)(2)(A), shall be reimbursed in accordance with Section 140.464(b)  for covered services provided to a Maternal and Child Health Program participant, as described in Section 140.922.

2)         Participating encounter rate clinics shall be reimbursed in accordance with Section 140.464(b) for covered services provided to a Maternal and Child Health Program participant, as described in Section 140.922.

3)         Participating providers described in Section 140.924(a)(1) shall be eligible to receive a Well Child Visit Incentive Payment.

A)        The provider will receive a one time annual payment of $30 for each qualifying child.

B)        A qualifying child is a child who had its first, second, third, fourth or fifth birthday during the calendar year and for whom the provider personally, or through an affiliated provider, rendered all recommended well child visits, as described in Section 140.488.

C)        Recommended services must be rendered during the 13-month period ending one month after the child's birthday.  For children turning one year old, the period begins ten days after birth and ends one month after the child's birthday.  Rendering of services will be based on Department claims data.

D)        Payments will be made at least annually.

E)        For the purpose of payments under this Section, "affiliated provider" shall mean providers designated pursuant to Section 140.994.

b)         Patient Management Fee

Providers who have accepted primary care responsibilities for foster children residing in Cook County who are under the guardianship of the Department of Children and Family Services will receive a monthly patient management fee for each client enrolled with them.

c)         Case Management Services

Providers of case management services will receive monthly payments.  The payments will be prorated based upon an annual amount per case.

(Source:  Amended at 38 Ill. Reg. 15081, effective July 2, 2014)