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(305 ILCS 5/5-19)
(from Ch. 23, par. 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
(d) Medical Screening Examinations.
(1) The Illinois Department shall insure Medicaid
coverage for periodic health, vision, hearing, and dental screenings for children eligible for Healthy Kids services scheduled from a child's birth up until the child turns 21 years. The Illinois Department shall pay for vision, hearing, dental and health screening examinations for any child eligible for Healthy Kids services by qualified providers at intervals established by Department rules.
(2) The Illinois Department shall pay for an
interperiodic health, vision, hearing, or dental screening examination for any child eligible for Healthy Kids services whenever an examination is:
(A) requested by a child's parent, guardian, or
custodian, or is determined to be necessary or appropriate by social services, developmental, health, or educational personnel; or
(B) necessary for enrollment in school; or
(C) necessary for enrollment in a licensed day
care program, including Head Start; or
(D) necessary for placement in a licensed child
welfare facility, including a foster home, group home or child care institution; or
(E) necessary for attendance at a camping
(F) necessary for participation in an organized
(G) necessary for enrollment in an early
childhood education program recognized by the Illinois State Board of Education; or
(H) necessary for participation in a Women,
Infant, and Children (WIC) program; or
(I) deemed appropriate by the Illinois Department.
(e) Minimum Screening Protocols For Periodic Health Screening
Examinations. Health Screening Examinations must include the following
(1) Comprehensive Health and Development Assessment
(A) Development/Mental Health/Psychosocial
(B) Assessment of nutritional status including
tests for iron deficiency and anemia for children at the following ages: 9 months, 2 years, 8 years, and 18 years;
(2) Comprehensive unclothed physical exam;
(3) Appropriate immunizations at a minimum, as
required by the Secretary of the U.S. Department of Health and Human Services under 42 U.S.C. 1396d(r).
(4) Appropriate laboratory tests including blood lead
levels appropriate for age and risk factors.
(A) Anemia test.
(B) Sickle cell test.
(C) Tuberculin test at 12 months of age and every
1-2 years thereafter unless the treating health care professional determines that testing is medically contraindicated.
(D) Other -- The Illinois Department shall insure
that testing for HIV, drug exposure, and sexually transmitted diseases is provided for as clinically indicated.
(5) Health Education. The Illinois Department shall
require providers to provide anticipatory guidance as recommended by the American Academy of Pediatrics.
(6) Vision Screening. The Illinois Department shall
require providers to provide vision screenings consistent with those set forth in the Department of Public Health's Administrative Rules.
(7) Hearing Screening. The Illinois Department shall
require providers to provide hearing screenings consistent with those set forth in the Department of Public Health's Administrative Rules.
(8) Dental Screening. The Illinois Department shall
require providers to provide dental screenings consistent with those set forth in the Department of Public Health's Administrative Rules.
(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
(g) Notice of Healthy Kids Services.
(1) The Illinois Department shall inform any child
eligible for Healthy Kids services and the child's family about the benefits provided under the Healthy Kids Program, including, but not limited to, the following: what services are available under Healthy Kids, including discussion of the periodicity schedules and immunization schedules, that services are provided at no cost to eligible children, the benefits of preventive health care, where the services are available, how to obtain them, and that necessary transportation and scheduling assistance is available.
(2) The Illinois Department shall widely disseminate
information regarding the availability of the Healthy Kids Program throughout the State by outreach activities which shall include, but not be limited to, (i) the development of cooperation agreements with local school districts, public health agencies, clinics, hospitals and other health care providers, including developmental disability and mental health providers, and with charities, to notify the constituents of each of the Program and assist individuals, as feasible, with applying for the Program, (ii) using the media for public service announcements and advertisements of the Program, and (iii) developing posters advertising the Program for display in hospital and clinic waiting rooms.
(3) The Illinois Department shall utilize accepted
methods for informing persons who are illiterate, blind, deaf, or cannot understand the English language, including but not limited to public services announcements and advertisements in the foreign language media of radio, television and newspapers.
(4) The Illinois Department shall provide notice of
the Healthy Kids Program to every child eligible for Healthy Kids services and his or her family at the following times:
(A) orally by the intake worker and in writing at
the time of application for Medical Assistance;
(B) at the time the applicant is informed that he
or she is eligible for Medical Assistance benefits; and
(C) at least 20 days before the date of any
periodic health, vision, hearing, and dental examination for any child eligible for Healthy Kids services. Notice given under this subparagraph (C) must state that a screening examination is due under the periodicity schedules and must advise the eligible child and his or her family that the Illinois Department will provide assistance in scheduling an appointment and arranging medical transportation.
(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
(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.)