Please join us in making the future of today's youth and tomorrow's leaders healthy and bright. Your medical interventions will make a difference -

Become an Active Provider in our Healthy Kids Programs

Each year, the Illinois Department of Healthcare and Family Services (HFS) covers over one million children under the HFS's Medical Programs and provides coverage for medical care of approximately 40 percent of Illinois' births. It is our goal to ensure that the highest quality health care is afforded to our most precious, yet most vulnerable resource, Illinois' children. Protecting and improving the health of Illinois' children is one of the state's highest priorities.

The Early and Periodic Screening, Diagnostic and Treatment program (EPSDT) is the nation's largest preventive child health initiative. It is a comprehensive child health program that provides for initial and periodic examinations and medically necessary follow-up care. Illinois strives to ensure that children covered by HFS's Medical Programs receive preventive health screening services, including immunization and lead screening, through Illinois' EPSDT program, called Healthy Kids. It is our commitment to families to establish access to quality primary and preventive health care services at a level equal to the general population. A primary goal is to "put prevention into practice." Through partnership with you, Illinois' children can be provided with "a medical home" as further defined in the American Academy of Pediatrics (AAP) Policy Statement, for efficient, high quality health care, and can receive needed referrals for health and health-related specialty care.

The Handbook for Providers of Healthy Kids Services, Chapter HK-200, specifically describes the components and frequency with which well-child screening services are to be performed under the Healthy Kids program. It also describes the EPSDT benefits available to HFS’s Medical Program participants who are under the age of 21, as mandated by the Social Security Act.

For information on enrolling as a provider, please contact:

E-mail: PPU@idpa.state.il.us

Mail:
Healthcare and Family Services
Provider Participation Unit
Post Office Box 19114
Springfield, Illinois 62794-9114
Fax: 217-557-8800

For eligibility information, providers may call the Provider Eligibility Inquiry Hotline at 1-800-842-1461.

Families who have questions about HFS’s Medical Programs may call 1-866-4-OUR-KIDS (1-866-468-7543) (TTY:1-877-204-1012).

Healthy Kids

In Illinois, Healthy Kids is the preventive health screening (well-child/medical) portion of the EPSDT benefit. Individuals under age 21 who receive Medical Assistance benefits receive preventive health screening without patient co-payments (refer to the Chapter 100, Topics 114 and 114.1).

Section 1905(r) of the Social Security Act (Act), 42 USC 1396d(r), sets forth the basic requirements of EPSDT. Under EPSDT, health screening, vision, hearing and dental services are to be provided at intervals which meet reasonable standards of medical and dental practice. The Act requires that any service that is permitted to be covered under HFS’s Medical Programs that is necessary to treat or ameliorate a defect, physical or mental illness, or a condition identified by a screen, must be covered.

HFS requires all preventive health screening services be delivered consistent with guidelines published by the Committee on Practice and Ambulatory Medicine; American Academy of Pediatrics (AAP) or the American Academy of Family Physicians (AAFP); the Advisory Committee on Immunization Practices (ACIP) and procedures and protocols established by the Illinois Department of Public Health (IDPH).

The EPSDT program consists of two, mutually supportive, operational goals, as federally required:

• Assuring the availability and accessibility of required health care resources, and
• Helping program participants and their parents use them, as requested

EPSDT DEFINITION

Early: assessing a child's health early in life so that potential diseases and disabilities can be prevented or detected in their preliminary stages, when they are most effectively treated. (This means as early as possible in a child's life in the case of a family already receiving medical benefits or as soon as a child's eligibility has been established.)

Periodic: assessing a child's health at regular intervals in the child's life to ensure continued healthy development. The Act requires periodicity schedules sufficient to ensure that at least a minimum number of health examinations occur at critical points in a child's life, and that medically necessary interperiodic screens be provided.

Screening: preventive services utilizing special tests or standardized examinations in order to identify those children who require specialized intervention. Four categories of screenings covered under the program are: medical, vision, hearing and dental.

Diagnosis: This formal evaluation process results in a diagnosis or determination of the cause of an abnormal screening test, symptom or sign and recommendation for treatment. Diagnostic evaluation is required if a screening examination indicates the need for a more complete assessment of a child's health status.

Treatment: the provision of medical services needed to control, correct or lessen health problems, including care coordination for chronic conditions.

HFS encourages participants' continuity of care with a primary care provider who coordinates needed services and provides continuing comprehensive care in a Medical Home setting. These include:

• Preventive care (periodic health screening), including health supervision and anticipatory guidance;
• Diagnosis and treatment of acute and chronic illness - ambulatory and inpatient care;
• Care over an extended period of time;
• Identification of need for subspecialty consultation and referrals;
• Interaction with other involved health, social, environmental and educational entities; and
• Maintenance of a central medical record for all pertinent medical information.

Links:

Children's Mental Health

Ounce of Prevention Fund Social Emotional Development

Zero To Three

HFS Provider Releases and Notices and Bulletins

HFS Provider Releases and Bulletins E-mail Notification Request

Handbook for Providers of Healthy Kids Services (HK-200)

Resources:

American Academy of Pediatrics

American Academy of Pediatrics-Bright Futures

Georgetown University Maternal and Child Health Library