Section 630.10  Legislative Base

 

a)         Federal

Legislative provisions for health services for mothers and children were initiated with Title V of the Social Security Act in 1935 (42 U.S.C. 701 et seq.) through formula grants to States for maternal and child health services.  Over the next 50 years Title V has been broadened and expanded in response to changing need.  The most recent and extensive revision to Title V came through the Maternal and Child Health (MCH) Services Block Grant Act of 1981 (PL 97-35; Sec. 2191 et seq.).  The MCH Block Grant Act virtually rewrote Title V to provide federal funds to states through a block grant arrangement so that each State could allocate resources based upon its individual needs and circumstances.  In addition to the Maternal and Child Health and Crippled Children's Service (CCS) components, previous federal categorical grant programs for Sudden Infant Death Syndrome (SIDS), Lead Screening, Adolescent Pregnancy, Genetics, Hemophilia and Supplemental Security Income − Disabled Children's Program (SSI-DCP) were folded into the MCH Block.  Each State is to determine the types of activities and the level of support for each type of project that would be included in its State MCH Program.

 

b)         State

 

1)         On July 12, 1877, the Illinois Department of Public Health was established to regulate the practice of medicine and to promote sanitary and hygienic activities.  In 1919 the Division of Child Hygiene and Public Health Nursing was created to address the health needs of mothers and children following a terrible epidemic of infantile paralysis (polio) which struck the State in 1916 and 1917.

 

2)         Since that time a wide array of state health department programs were developed by this Division and its various successor units.  After the enactment of Title V legislation, the Division became the designated maternal and child health unit of the Department.

 

3)         The Division of Family Health carries responsibility for implementing and maintaining Federal Title V programs as well as the following program areas mandated by state legislation:  

 

A)        Developmental Disability Prevention Act [410 ILCS 250]

 

B)        Newborn Metabolic Screening Act [410 ILCS 240]

 

C)        Division 3.3 of the Counties Code [55 ILCS 5]

 

D)        Lead Poisoning Prevention Act [410 ILCS 45]

 

E)        Illinois Family Case Management Act [410 ILCS 212]

 

F)         The Problem Pregnancy Health Services and Care Act [410 ILCS 230]

 

G)        Prenatal and Newborn Care Act [410 ILCS 225]

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.20  Administration

 

a)         General Provisions

 

1)         Planning, programming and budgeting for Maternal and Child Health (MCH) programs are the responsibility of the Illinois Department of Public Health.  The Department will develop each year an MCH Program Plan for Illinois which will assess current needs within the State and provide goals and objectives for improving the health of mothers and children, and for reducing infant mortality. The Department will provide to the University of Illinois, Division of Specialized Care for Children at least the amount of federal Maternal and Child Health Services Block Grant funds required by Title V of the Social Security Act (42 USC 705(a)(3)(B)) for services for children with special health care needs.  These services are defined in Title V of the Social Security Act (42 USC 701(a)(1)(D) et seq.) and are further defined in State law at 110 ILCS 345 and 110 ILCS 305 and in 89 Ill. Adm. Code 1200.  The funds provided to the University of Illinois, Division of Specialized Care for Children for this purpose are not subject to the other requirements in this Part.

 

2)         Giving highest priority to those areas in Illinois having high concentrations of low-income families, medically underserved areas, and those areas with high infant mortality and teenage pregnancies, the Department shall use the remaining percentage of the total MCH Services Block Grant funds for MCH Projects consistent with the intent of Title V and to provide Department operational funds which are supportive of the above projects.

 

3)         Projects shall be administered either directly by the Department, or through grants or contracts to health agencies of local political jurisdictions or private nonprofit agencies.  All applicant agencies shall be subject to the planning, promotion, and coordination of such services by the Department.

 

4)         Each project shall operate according to a plan written in accordance with State guidelines contained in this Part that are consistent with Title V and its regulations.  In addition, projects funded for Regionalized Perinatal Care, Lead Poisoning, Newborn Screening, Problem Pregnancy, or Sudden Infant Death Syndrome activities must meet the requirements of State statutes and their applicable State rules and regulations.

 

b)         Review Process

 

1)         Priorities for Ranking

 

A)        Priority shall be given to project applications for areas with concentrations of low income families.  A low income family is defined as being either urban or rural, with an annual income below the nonfarm income official poverty level as defined by the Office of Management and Budget and revised annually in accordance with Section 624 of the Economic Opportunity Act of 1964.  An area of concentration of low income is defined as a geographic area in which data are available indicating that a minimum of 20% of families or at least 1,000 individuals within its boundaries have an income less than the poverty level as described above.  Priority will be given to those geographic areas in proportion to the extent to which the standard is exceeded.  Applicants shall be required to document the socioeconomic factors within the geographic area proposed for the project.

 

B)        Priority for placement of projects shall also be given to areas that demonstrate a need for health services because of service scarcity or inaccessibility, and areas determined to have a need for such services as documented in the Illinois MCH Program Plan, revised annually.  Areas demonstrating a reasonable probability of success based upon availability of facilities and personnel or the potential for developing such resources shall also be given priority.

 

C)        Reapplications for continued funding will receive priority consideration in two succeeding years based on appropriation of funds by the General Assembly and performance showing progress toward stated goals. Funding for subsequent reapplications will be based upon the priorities in subsections (b)(1)(A) and (b)(1)(B) of this Section and past performance.

 

2)         Processing of Applications

 

A)        Applications shall be submitted no later than the due date indicated in the Request for Proposal (RFP) which shall be approximately ten weeks from the date of the request. All exceptions must be requested and approved in writing.

 

B)        Staff of the Department shall review the applications for completeness and request any needed additional information from the applicant.

 

C)        An evaluation committee appointed by the Chief of the Division of Family Health shall review all applications based on compliance with this Part. Documentation of the review process shall be a summary of ratings for all proposals reviewed. The review shall include as a minimum the items identified in the MCH Grant Proposal Review Form. Such items include but are not limited to linkages with other community resources, parental involvement in the program, matching fund requirements, and special budgetary justification.

 

D)        Upon consideration of the recommendations of the evaluation committee, the Chief of the Division of Family Health shall recommend a funding level for approved applications to the Director of the Illinois Department of Public Health.  The Illinois Department of Public Health may award funds for amounts less than requested in the grant application.

 

E)        The Department will communicate final decisions to each applicant.

 

c)         Funding.  The preferred method of payment to Maternal and Child Health projects is by reimbursement of expenditures.  In those instances in which a grantee does not have at least two months operating funds to implement the project, a cash advance may be requested.  The request must be in writing and signed by the agency director. Repayment and reconciliation methodology will be set forth in writing by the Chief, Division of Family Health, as a part of the agreement.

 

d)         Reimbursement

 

1)         Periodic requests for reimbursement of allowable expenses incurred in the operation of the project and as specified in the approved budget are to be prepared and submitted to the Office of Community Health Fiscal Unit.  After review by appropriate fiscal and MCH staff, and approval by the MCH Program personnel, reimbursement requests will be processed for payment.  Payment usually can be expected from five to six weeks after receipt of the reimbursement request by the Department.  If unallowable expense items are included in the reimbursement request, they will be deducted, the project director will be notified, and only the allowable portion of the request will be reimbursed.  In order to expedite cash flow, project directors should inquire about the appropriateness of questionable expenses prior to making the expenditure.

 

2)         Complete reimbursement request shall consist of a Reimbursement Certification Form which can be expanded to multiple pages where necessary.  Billings should be prepared in accordance with the following instructions:

 

A)        Frequency of submission:  Projects with funding in excess of $50,000 shall submit billings monthly.  All others should submit billings at least quarterly. Any project may submit monthly billings. Quarters for the MCH grant periods are:

 

	State Fiscal Year	Federal Fiscal Year
July 1-September 30	1st	4th
Oct. 1-December 31	2nd	1st
Jan. 1-March 31	3rd	2nd
April 1-June 30	4th	3rd

 

B)        Deadlines for submission:  Billings must be submitted within 30 days after the end of the reporting period.  For example, billing for the month of July shall be submitted not later than the end of August, billing for the quarter ending in March shall be submitted not later than the end of April. At the end of the grant period, however, projects will have 45 days in which to submit the final billing.

 

C)        Grouping of expenditures:  Billing must be organized by the budget categories and line items of the approved project budget.  A total for each budget category shall be shown.

 

D)        Voucher or check number:  Every expenditure (goods or services already paid for by the grantee) must be identified by a voucher number or check number.  This is the key to maintaining a clearly defined audit trail.  Each item reimbursed by the Division of Family Health or voluntarily shown as supporting expenditures must be based on an expenditure traceable through the project's internal record system. Invoices, bills, purchase orders, etc., shall be attached or cross referenced on the grantee's voucher or check stub and kept on file for 3 years beyond the end of the grant period.  These are not to be submitted with project billings.

 

E)        Date of voucher or check:  Expenditures must be documented by showing the date of issue of the voucher or check.

 

F)         Expenditures outside of report period:  It is expected that reimbursement requests will be for goods and services received in the reporting period.  Bills submitted to the project by providers, suppliers, etc., too late for inclusion may be submitted with the subsequent billing request.

 

G)        Payee:  Clearly identify (by name and address) the organization or individual to whom payment was made.

 

H)        Purpose of expenditure:  The purpose of the expenditure must be clearly indicated so that the Division of Family Health staff may determine whether it is acceptable for reimbursement or as matching.  Acceptability will be based on the terms of the agreement and this Part.  For periodic charges, e.g., salaries, fringe benefits, travel, rent, utilities, etc., also show the time period covered.

 

I)         Patient confidentiality:  Patients' names shall not appear anywhere on the billing.  Where patient references are necessary to maintain an audit trail, patient numbers or other means of identification shall be used.

 

J)         Expenditure:  Expenditures shall be completed in accord with Instructions for Completion of the Reimbursement Certification Form (see Appendix B of this Part).

 

i)          Subtotal expenditures in both columns by budget category, and show a grand total at the end of the billing.

 

ii)         Individual expenditures reported may be entirely reimbursable, entirely paid from other resources, or a combination of the two.  For example, a nurse's salary may be paid entirely by grant funds, entirely by local project funds, or partly from each source.

 

iii)        In projects showing supporting expenditures, they are to be reported with each reimbursement request and not accumulated.

 

K)        Signature:  The project director or an authorized agent must sign the billing form before submission.  The individual signing the form is responsible for its accuracy. Authorized signatures must be on file with the Department.

 

L)        Number of copies:  Submit four legible copies of the Reimbursement Certification Form. Additional pages may be duplicated as needed.

 

e)         Monitoring.  At least annually, appropriate professional health personnel of the Division and its consultants shall review each project for appropriateness of services and quality of care furnished to recipients in accordance with the project plan.

 

f)         Auditing

 

1)         The Grantee will maintain complete records of all services, receipts and disbursements relative to the grant agreement and agrees to make all such records available to the Department and its agents for audit in accordance with applicable requirements.

 

A)        Local Governments:  Audits shall be conducted in accordance with the Single Audit Act of 1984 (31 USC 7501 et seq.) and OMB Circular A-128 "Audits of State and Local Governments".  All records related to the grant agreement shall be retained and available during normal business hours for three years following termination of the grant agreement or for such time as may be provided in applicable State and federal statutes and administrative rules, whichever time is longer.  The Grantee shall maintain all records that are subject to an active or announced audit until such audit is completed and all outstanding audit issues have been resolved.

 

B)        Nonprofit Organizations:  Audits shall be conducted in accordance with OMB Circular A-133 "Audits of Institutions of Higher Education and Other Nonprofit Organizations".  All records related to the grant agreement shall be retained and available during normal business hours for three years following termination of the grant agreement or for such time as may be provided in applicable State and federal statutes and administrative rules, whichever is longer.  The Grantee shall maintain all records that are subject to an active or announced audit until such audit is completed and all outstanding audit issues have been resolved.

 

2)         Organizations falling under the audit provisions cited above must submit a copy of the audit report to the Illinois Department of Public Health within one month after the receipt of the final report.  For any organizations not specifically covered under the above-stated audit requirements or, if after review of the report, the Illinois Department of Public Health requires additional information, the Department reserves the right to perform such an audit in accordance with the Fiscal Control and Internal Auditing Act [30 ILCS 10].

 

(Source:  Amended at 26 Ill. Reg. 14991, effective October 1, 2002)

 

Section 630.25  Incorporated Materials

 

The following are standards incorporated or referenced in this Part:

 

a)         Codes and Standards

 

1)         Accreditation Manual for Hospitals (1990)

The Joint Commission

One Renaissance Boulevard

Oak Brook Terrace IL 60181

 

2)         Hospital Care of Children and Youth (1986)

American Academy of Pediatrics

141 Northwest Point Blvd.

P .O. Box 927

Elk Grove Village, Illinois 60009-0927

 

3)         Guidelines for Perinatal Care (1988)

American Academy of Pediatrics

141 Northwest Point Blvd.

P .O. Box 927

Elk Grove Village, Illinois 60009-0927

 

American Congress of Obstretricians and Gynecologists

409 12^th Street S.W.

Washington, D.C. 20024-2188

 

March of Dimes

1275 Mamaroneck Avenue

White Plains, N.Y. 20024-2188

 

4)         Towards Improving the Outcome of Pregnancy (1977)

National Foundation − March of Dimes

The Committee on Perinatal Health

1275 Mamaroneck Avenue

White Plains, N.Y. 20024-2188

 

5)         Standards of Child Health Care (1977)

Council on Pediatric Practice

American Academy of Pediatrics

141 Northwest Point Blvd.

P .O. Box 927

Elk Grove Village, Illinois 60009-0927

 

6)         Standards for Obstetric − Gynecologic Services

American Congress of Obstetricians and Gynecologists

7^th edition 1985

409 12^th Street S.W.

Washington, D.C. 20024-2188

 

7)         School Health:  A Guide for Health Professionals (1987)

American Academy of Pediatrics

141 Northwest Point Blvd.

P .O. Box 927

Elk Grove Village, Illinois 60009-0927

 

8)                  Standard of Maternal and Child Health Nursing Practice (1983)

American Nurses Association

8515 Georgia Avenue

Suite 400

Silver Springs MD 20910

 

9)         A Statement on the Scope of Maternal and Child

Nursing Practice (1980)

American Nurses Association

8515 Georgia Avenue

Suite 400

Silver Springs MD 20910

 

10)       Standard of Practice for the Perinatal Nurse (1984)

American Nurses Association

8515 Georgia Avenue

Suite 400

Silver Spring MD 20910

 

11)       Standard of Community Health Nursing Practice (1986)

American Nurses Association

8515 Georgia Avenue

Suite 400

Silver Springs MD 20910

 

12)       Definition and Role of Public Health Nursing in the Delivery of Health Care (1980)

American Public Health Association

800 I Street N.W.

Washington, D.C. 2001

 

b)         Federal Guidelines, Statutes and Regulations

 

1)         Rehabilitation Act of 1973 (See Section 630.200(e)(9))

 

2)         Title IX of the Education Amendments of 1972 (See Section 630.200(e)(9))

 

3)         Age Discrimination Act of 1975 (See Section 630.200(e)(9))

 

4)         Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000e et seq.) (See Section 630.200(e)(9))

 

5)         Title V of the Social Security Act of 1935 (42 U.S.C 701 et seq.) (See Section 630.10(a), 630.20(a)(4), 630.100(a)(1))

 

6)         Section 1861(v) of the Social Security Act (42 U.S.C. 1395v) (See Section 630.190)

 

7)         Section 1122 of the Social Security Act (42 U.S.C. 1320a) (See Section 630.190)

 

8)         Maternal and Child Health (MCH) Services Block Grant Act of 1981 (P.L. 97-35; Sec. 2191 et seq.) (See Section 630.10(a))

 

9)         Section 624 of the Economic Opportunity Act of 1964 (See Section 630.20(b)(1)(A))

 

10)         Single Audit Act of 1984 (31 U.S.C. 7501 et seq.) (See Section 630.20(f))

 

11)         42 CFR 50.201 (1990) (See Section 630.180(b))

 

c)         State of Illinois Statutes

 

1)         Developmental Disability Prevention Act [410 ILCS 250] (See Section 630.10(b))

 

2)         Newborn Metabolic Screening Act [410 ILCS 240] (See Section 630.10(b))

 

3)         Division 3.3 of the Counties Code [55 ILCS 5] (See Section 630.10(b))

 

4)         Lead Poisoning Prevention Act [410 ILCS 45] (See Section 630.10(b))

 

5)         Illinois Family Care Management Act [410 ILCS 212] (See Section 630.10(b))

 

6)         The Problem Pregnancy Health Services and Care Act [410 ILCS 230/1-100] (See Section 630.10(b)

 

7)         Prenatal and Newborn Care Act [410 ILCS 225] (See Section 630.10(b))

 

8)         Specialized Care for Children Act [110 ILCS 345] (See Section 630.20(a)(1))

 

9)         The University of Illinois Act [110 ILCS 305 (See Section 630.20(a)(1))

 

10)         AN ACT in relation to the establishment and maintenance of county and multiple-county public health departments (Ill. Rev. Stat. 1989, ch. 111½, par. 20c.01) (See Section 630.20(f))

 

11)         State Finance Act [30 ILCS 105] (See Section 630.70 definition of "Equipment.")

 

12)         Article III of the Code of Civil Procedure [735 ILCS 5] (See Section 630.210)

 

d)         State of Illinois Regulations

 

1)         Family Planning Services Code (77 Ill. Adm. Code 635) (See Section 630.30)

 

2)         Newborn Metabolic Screening and Treatment Code (77 Ill. Adm. Code 661) (See Section 630.40(a)(3))

 

3)         Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640) (See Section 630.70 definition of "High-Risk")

 

4)         89 Ill. Adm. Code Part 1200 (See Section 630.20(a)(1))

 

5)         Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100) (See Section 630.200 (h)(5))

 

e)         All incorporations by reference of federal rules and the standards of nationally recognized organizations refer to the regulations and standards on the date specified and do not include any additions or deletions subsequent to the date specified.

 

(Source:  Amended at 15 Ill. Reg. 13874, effective September 27, 1991)

 

Section 630.30  Health Services for Women of Reproductive Age

 

The Division of Family Health, Department of Public Health, State of Illinois, through its Maternal and Child Health Program may allocate funds for programs providing health services for women of reproductive age. All such services must be delivered based upon the standards of the American Congress of Obstetricians and Gynecologists set forth in Section 630.80(a)(5), Family Planning Services Code (77 Ill. Adm. Code 635.90), Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640), and Hospital Licensing Requirements (77 Ill. Adm. Code 250.1810-1860) (See Section 630.80(a)(5)). One or more of the following MCH services may be included in application proposals for Title V and State MCH Project grant funds:

 

a)         Services for nonpregnant women that relate to the occurrence and course of future pregnancy.

 

1)         Comprehensive family planning services as described in the Department's Family Planning Services Code − 77 Ill. Adm. Code 635.90.

 

2)         Genetic evaluation counseling as indicated.

 

3)         Counseling and referral to licensed adoption services if indicated or desired.

 

b)         Services for pregnant woman.

 

1)         Early diagnosis of pregnancy.

 

2)         Counseling regarding plans for pregnancy continuation.

 

A)        For those electing to carry to term, referral for and provision of prenatal care.  Referral to childbirth preparation classes as desired or to adoption services at licensed agencies if indicated.

 

B)        For those electing abortion, referral to appropriate counseling and family planning facilities.

 

3)         Prenatal care services including:

 

A)        History (general medical-surgical, social and occupational, family and genetic background, health habits, previous pregnancies, and current pregnancy).

 

B)        Complete physical examination including blood pressure, height and weight, and fetal development as well as a complete systems review.

 

C)        Laboratory tests as appropriate, such as syphilis serology, Papanicolaou smear, gonococcal culture, chlamydia smear, hepatitis B, diabetic screening, hemoglobin/hematocrit, urinalysis for glucose and protein, Rh determination and irregular antibody screening, blood group determination, and rubella test.

 

D)        Diagnosis and treatment or referral and follow-up of general health problems, both acute and chronic, preexisting or arising during the prenatal period, that can adversely affect pregnancy, fetal development, or maternal health.

 

E)        Referral and follow-up of mental health problems, both acute and chronic, preexisting or arising during the prenatal period, that can adversely affect pregnancy, fetal development, or maternal health.

 

F)         Nutritional assessment and services as needed.  Provision of vitamin, iron and other supplements as appropriate. The water supply for clients on nonpublic sources should be tested for nitrates by the Illinois Department of Public Health Laboratories.

 

G)        Dental services limited to oral pathology that can directly affect the outcome of pregnancy.

 

H)        Subsequent prenatal visits should include at the minimum:  blood pressure, weight, urinalysis for protein and glucose, ascertaining fetal development, update on pertinent medical history, height of fundus, rate and location of fetal heart tones, periodic hemoglobin and/or hematocrit as well as a vaginal examination and other special tests as indicated (e.g., Rh titer). Visits should occur at ACOG recommended frequency.

 

I)         Screening, diagnosis (including amniocentesis), and counseling with follow-up for selected fetal genetic defects.

 

J)         An assessment to identify high risk pregnancies and appropriately consult and/or refer within the Perinatal System.

 

K)        Home health and homemaker services.

 

L)        Counseling and anticipatory guidance with referral and followup as needed regarding:

 

i)          Physical activity and exercise.

 

ii)         Nutrition during pregnancy, including the importance of adequate but not excessive weight gain.

 

iii)        Avoidance during pregnancy of smoking, alcohol and other drugs; and of environmental hazards including radiation, hazardous chemicals, and various workplace hazards.

 

iv)        Signs of problems arising during pregnancy and at the onset of labor, including signs of preterm labor.

 

v)         Preparation of the woman (and her partner where appropriate) for labor and delivery, including plans for place of delivery and use of anesthesia.

 

vi)        Use of medication during pregnancy.

 

vii)       Infant nutritional needs and feeding practices, including breast feeding.

 

viii)      Child care arrangements.

 

ix)        Parenting skills, including meeting the physical, emotional and intellectual needs of the infant, with specific appraisal to detect parents at risk of child abuse or neglect.

 

x)         Planning for continuous and comprehensive pediatric care following delivery, including arrangements for a pediatric antenatal visit to link the family to pediatric care.

 

xi)        Emotional and social changes occasioned by the birth of a child, including changes in marital and family relationships, the special needs of the mother in the postpartum period, and preparing the home for the arrival of the newborn.

 

xii)       Referral to appropriate community health resources such as WIC, food stamps, welfare and social services that can benefit health status significantly.

 

xiii)      Discussions regarding postpartum family planning options.

 

xiv)      Housing (including alternative placement).

 

xv)       Other relevant topics in response to patient concern.

 

4)         Services in the intrapartum period.

 

A)        Assessing the progress of labor and the condition of the mother and fetus throughout labor.

 

B)        Medical services during labor and delivery for diagnosis and management of conditions threatening the mother and/or infant, including the availability of a Cesarean birth operation when indicated and consultation and/or referral for high risk perinatal problems within the Perinatal System.

 

C)        Delivery and/or referral of the baby to the appropriate level facility within the Perinatal System.

 

D)        RH workup and Rhogam administration as indicated.

 

5)         Services during the postpartum period.

 

A)        Diagnosis and treatment or referral and follow-up of general health problems, both acute and chronic, preexisting or arising during the postpartum period that can adversely affect the mother's health and/or child caring abilities.

 

B)        Diagnosis and treatment or referral and follow-up of mental health or behavioral problems, both acute and chronic, preexisting or arising during the perinatal and postpartum periods (including maternal depression) that can adversely affect the mother's health and/or child care abilities.

 

C)        Counseling and anticipatory guidance with referrals and follow-up as needed regarding:

 

i)          Postpartum changes, both normal and abnormal.

 

ii)         Family planning methods.

 

iii)        Infant development and behavior.

 

iv)        Infant nutritional needs and feeding practices, including breast feeding.

 

v)         Automobile restraints for infants and children, and general accident prevention concepts (especially home accidents and accidental poisoning).

 

vi)        Infant stimulation and parenting skills, with specific appraisal to identify parent as risk for child abuse or neglect.

 

vii)       Need for and importance of immunizations.

 

viii)      Effect on children of parental smoking, use of alcohol and other drugs, and other health-damaging behaviors.

 

ix)        The importance of a source of continuous and comprehensive care for both mother and child, including identification of available resources to help with such problems as illness in the newborn, breast feeding difficulties or problems with contraception.

 

x)         Recognition and management of illness in the newborn.

 

xi)        Infant care.

 

xii)       Child care arrangements.

 

xiii)      Using community health resources such as WIC, food stamps, welfare and social services that bear significantly on health status.

 

xiv)      Physical activity and exercise.

 

xv)       Nutrition assessment and services.

 

xvi)      General health practices.

 

xvii)     Genetic diagnostic services and counseling if indicated.

 

xviii)    Other relevant topics in response to parental concern.

 

xix)      Organic medical problems such as renal and heart disease, hypertension, diabetes, and endocrine problems.

 

D)        Diagnosis and treatment or referral and follow-up for general health problems (of project registrants) that can adversely affect future pregnancy, fetal development, and maternal health such as:

 

i)          Sexually transmitted diseases.

 

ii)         Immune status (such as rubella).

 

iii)        Gynecological anatomic and functional disorders.

 

iv)        Inadequate nutritional status, including both under and overweight.

 

v)         Occupational exposures.

 

vi)        Acute dental problems such as infection.

 

vii)       Family history of genetic disorder.

 

E)        Comprehensive family planning services, during intrapartum and postpartum period, including:

 

i)          Information, education, and counseling regarding family planning concepts and techniques, and other issues such as the importance of prenatal care, and risks to mother and child of childbearing at extremes of the reproductive age span.

 

ii)         History and physical examination, including heart, lungs, thyroid, breast and pelvic examination, as indicated, and tests such as a Papanicolaou smear, gonococcal culture, chlamydia testing, hematocrit urinalysis, and serological examination for syphilis, as appropriate.

 

iii)        Provision of family planning methods and instruction regarding their use.

 

iv)        Sterilization counseling, information, and education.

 

v)         Sterilization treatment services for persons 21 years of age and over, and legally capable of consent.

 

vi)        Rubella immunization as indicated.

 

vii)       Genetic counseling services.

 

F)         Home health and homemaker services.

 

G)        Routine postpartum examination, four to six weeks following delivery with referrals and follow-up as needed, including:

 

i)          Physical examination and intrapartum history.

 

ii)         Laboratory services as appropriate.

 

iii)        Family planning services.

 

iv)        Rubella immunization as indicated.

 

c)         Access-related services:

 

1)         Outreach services.

 

2)         Translator and 24-hour emergency telephone services.

 

3)         Child care services to facilitate obtaining needed health services and other social services as needed.

 

4)         Availability of services directly or through referral regardless of handicapping conditions.

 

5)         Transportation.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.40  Health Services For Children In The First Year Of Life

 

The Division of Community Health and Prevention, State of Illinois Department of Public Health, through its Maternal and Child Health Program may allocate funds for programs providing health services for infants in the first year of life in accord with the standards of the American Academy of Pediatrics set forth in Section 630.80(a)(5), and Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640).  One or more of the following MCH services may be included in application proposals for Title V and State MCH Project grant funds.

 

a)         Services in the Neonatal Period

 

1)         Evaluation of the newborn infant immediately after delivery and institution of appropriate support procedures.

 

2)         Complete physical examination, including length, weight, and head circumference, skin, head, eyes, ears, nose, mouth, thorax, lungs, cardiovascular system, abdomen, genitalia, musculoskeletal system, neuromuscular system and reflexes.

 

3)         Laboratory tests to screen for lead poisoning and genetically-determined diseases as defined in the Newborn Metabolic Screening and Treatment Code (77 Ill. Adm. Code 661).

 

4)         Diagnosis and treatment or referral and follow-up of general health problems.

 

5)         Preventive procedures to include:

 

A)        Gonococcal eye infection prophylaxis.

 

B)        Administration of vitamin K.

 

6)         Assessment for high risk conditions and appropriate consultation and/or referral within the Perinatal System including genetic evaluation and counseling services where appropriate.

 

7)         Nutritional assessment and services and supplementation as needed.

 

8)         Bonding and attachment support activities including provision for extended contact between parents and their infant immediately after delivery and, where desired by the parents, rooming-in arrangements or the equivalent.

 

9)         Arrangements for continuous, comprehensive pediatric care for the newborn following discharge from the hospital.

 

10)         Home health services.

 

11)         Referral for Public Health nursing follow-up including those identified through the Adverse Pregnancy Outcome Reporting System.

 

b)         Services During Balance of First Year of Life

 

1)         Periodic health assessment to include:

 

A)        History and systems review (general medical and social, family and genetic background, with items of inquiry determined by age, developmental stage, and likelihood of potential problems).

 

B)        Complete physical examination to include:

 

i)          Height and weight.

 

ii)         Head circumference.

 

iii)        Vision and hearing evaluation.

 

C)        Assessment of Development and Behavior using age appropriate tools.

 

D)        Screening and laboratory tests as indicated, including hemoglobin/hematocrit and tuberculin skin test; and, for infants at risk, such procedures as lead poisoning, parasite, and sickle cell screening for those children not screened in the newborn period.

 

E)        Nutritional assessment, services and supplementation as needed (including provision of such supplements as iron and vitamin D, and adequacy of fluoride intake). For those clients on nonpublic supplies, water should be tested for nitrates by the Illinois Department of Public Health Laboratories.

 

2)         Immunizations according to state and nationally recognized standards.

 

3)         Diagnosis and treatment or referral and follow-up of general health problems, both acute and chronic.

 

4)         Home health services.

 

5)         Counseling and anticipatory guidance with referrals and follow-up as needed regarding:

 

A)        Infant development and behavior.

 

B)        Maternal nutritional needs, especially if breast feeding, and infant nutritional needs and feeding practices.

 

C)        Automobile restraints for infants, and general injury prevention concepts (especially home injuries and unintentional poisoning).

 

D)        Infant stimulation and parenting skills, with appraisal to identify parents at risk of child abuse or neglect.

 

E)        Need for and importance of immunizations.

 

F)         Effect on children of parental smoking, use of alcohol and other drugs, and other health-damaging behaviors.

 

G)        The importance of a source of continuous and comprehensive care for mother and child, including identification of available resources to help with such problems, as sudden illness or breast-feeding difficulties.

 

H)        Recognition and management of illness.

 

I)         Infant care skills.

 

J)         Child care arrangements.

 

K)        Using community health resources such as WIC, food stamps, welfare and social services that significantly affect health status.

 

L)        Other relevant topics in response to parental concern.

 

6)         Counseling and provision of appropriate treatment and/or referral to appropriate services (including Early Intervention Programs for Infants and Toddlers with Handicaps, programs for children with special health care needs, home health and homemaker services) as needed for parents:

 

A)        who have health problems that seriously affect their capacity to care for the infant.

 

B)        whose infant is seriously ill.

 

C)        whose infant has a chronic illness or handicapping condition.

 

D)        whose infant is or is about to be hospitalized.

 

c)         SIDS

Education, information and counseling services for all families whose infants die as a result of Sudden Infant Death Syndrome (SIDS), as well as training for those professionals who would be involved in a SIDS incident.

 

1)         Coroners report suspected SIDS cases to Statewide SIDS Program within 72 hours.

 

2)         Condolence letter and SIDS information sent to family.

 

3)         Referral to local agency for family follow-up.

 

A)        Family is contacted to schedule a home visit and the completed initial home visit report is returned to SIDS Program within two weeks.

 

B)        Follow-up visit report form returned after subsequent visits or telephone contacts.

 

4)         Counseling and/or referral to appropriate services or support groups as needed. (Parent support groups, mental health).

 

5)         Workshops and/or in-services related to SIDS for professionals. Directed at, but not limited to, coroners, Emergency Medical Technicians, first responders, emergency room personnel, funeral home directors, clergy, social workers, and public health nurses.

 

d)         Local Health Nursing Follow-up for the High-Risk Mother

 

1)         Purpose

Home visits to families of high-risk/pregnant and postpartum women have a two-fold purpose: assessment of the woman and the family/environment and facilitation of early intervention for identified problems.

 

2)         Agencies to Provide Services

 

A)        All Local Health Departments shall provide follow-up services to residents of their counties.

 

B)        The Department may contract with a local health agency or county nurse to provide follow-up services to residents of areas without a Local Health Department.

 

3)         Eligibility for Services

Any pregnant or postpartum patient identified as high-risk by a Level III hospital and referred to a Local Health Department or other designated local health agency shall be offered follow-up services. The patient may decline those services.

 

4)         Services To Be Provided

 

A)        Home visits to high-risk pregnant women shall be scheduled as often as the client's condition warrants or as requested by the attending physician. A post-discharge visit shall be made as soon as possible after discharge. Additional visits may be made during the postpartum period (i.e., 6 weeks following the date of delivery) for pregnancy-related conditions as indicated or as requested by the attending physician. If additional visits are for chronic health conditions (e.g., chronic hypertension, CVA, advanced cardiac disease), the patient should be referred to the licensed home health agency in the area for long-term follow-up.

 

B)        Local health agencies that provide services must adhere to the provisions of this Part.

 

e)         Local Health Nursing Follow-up for High-Risk Infants

 

1)         Purpose

The purpose of the infant follow-up program is to minimize disability in high-risk infants by identifying as early as possible conditions requiring further evaluation, diagnosis, and treatment and by assuring an environment that will promote optimal growth and development.

 

2)         Agencies to Provide Services

 

A)        All Local Health Departments shall provide follow-up services to residents of their counties.

 

B)        The Department may contract with a local health agency to provide follow-up services to residents of areas without a Local Health Department.

 

3)         Eligibility for Services

Any infant eligible for the Adverse Pregnancy Outcomes Reporting System (APORS) and referred to a Local Health Department or other designated local health agency shall be offered follow-up services. The family may decline those services.

 

4)         Services To Be Provided

 

A)        A minimum of 6 visits shall be made by the follow-up nurse as soon as possible after newborn hospital discharge and at infant chronological ages 2, 6, 12, 18 and 24 months. Infants and their families having actual or potential health problems identified by the nurse shall be visited more frequently for health monitoring, teaching, counseling and/or referral for appropriate services. Occasionally, when an infant is receiving services at the Local Health Department, a follow-up visit may be conducted by the nurse at that time.

 

B)        Follow-up services shall include:

 

i)          Health history, including: prenatal and natal history; parental concerns; family history of genetic disease or unexplained mental retardation; compliance with medical regimen, if any, including medications, treatments and visits to the physician; infant care, including nutrition, elimination and sleep activity; and family/infant interaction, family coping and parental knowledge of injury prevention.

 

ii)         Physical assessment, developmental assessment, and age specific anticipatory guidance based on the American Congress of Obstetricians and Gynecologists guidelines or current recommendations of the State that are found in subsection (e)(5).

 

iii)        Based on the results of the health history and physical assessment, the nurse shall identify problems, make nursing diagnoses and arrange for intervention. Intervention may include: counseling the family as to the importance of regular primary health care by the family physician, pediatrician or clinic; encouraging scheduled return visits to the Perinatal Center; family teaching/counseling by the follow-up nurse; referral to the physician or other screening, diagnostic or support services depending on the nature of the problem; and follow-up on referrals.

 

5)         Local health agencies must adhere to the provisions of this Part and the Department's High Risk Infant Tracking Supplement for Local Health Departments, which may be obtained from the Department's Division of Community Health and Prevention.

 

f)         Access-Related Services

 

1)         Outreach services.

 

2)         Translator and 24-hour emergency telephone services.

 

3)         Child care services to facilitate obtaining needed health services.

 

4)         Availability of services directly or through referral for handicapping conditions.

 

5)         Transportation.

 

(Source:  Amended at 35 Ill. Reg. 452, effective December 22, 2010)

 

Section 630.50  Health Services For Children From One Year Of Age To Early Adolescence

 

The Department of Public Health, through its Maternal and Child Health Program may allocate funds for programs providing health services for children from one year of age to early adolescence which meet the standards of the American Academy of Pediatrics set forth in Section 630.80(a)(5).  One or more of the following MCH services may be included in application proposals for Title II and State MCH Project grant funds.  Some of the items apply primarily to either older or younger children (such as counseling regarding use of cigarettes by the child in the former case and initiation of the mumps, measles, and rubella immunization series in the latter).

 

a)         Health Services for Children

 

1)         Periodic health assessment to include:

 

A)        History and systems review (general medical and social, family and genetic background, with items of inquiry determined by age, developmental stage, and likelihood of potential problems).

 

B)        Psychosocial history, including peer and family relationships, and school progress and problems, out-of-school activities, and health-related habits.

 

C)        Complete physical examination to include:

 

i)          Height and weight, head circumference through the second year of life, skin, head and neck, thorax, lungs, cardiovascular system, abdomen, genitalia, musculoskeletal system, nervous system, and mental status.

 

ii)         Sexual development.

 

iii)        Vision, hearing, and speech evaluation.

 

iv)        Blood pressure starting at age 3.

 

v)         Dental.

 

D)        Developmental and behavioral assessment using age appropriate tools.

 

E)        Screening and laboratory tests as indicated, including hemoglobin/hematocrit, blood lead analysis and tuberculin skin test (Mantoux) in children from high-risk groups or in areas of high endemic rates of tuberculosis; and, for children at risk, such procedures as parasite and sexually transmitted disease screening.

 

F)         Nutritional assessment, services and supplementation as needed (including provision of such supplements as iron and vitamin D, and fluoride if indicated). For those on nonpublic water supplies, testing for nitrates should be done by the Illinois Department of Public Health Laboratories.

 

2)         Immunizations according to state and nationally recognized standards.

 

3)         Diagnosis and treatment or referral and follow-up of general health problems, both acute and chronic.

 

4)         Diagnosis and treatment or referral and follow-up of mental health problems, both acute and chronic, including emotional and learning disorders, behavioral disorders, alcohol and drug related problems, and problems with family and peer group relationships.

 

5)         Counseling and provision of support services as needed to children with chronic illnesses and/or handicapping conditions.

 

6)         Dental services, both preventive and therapeutic, including oral examination, prophylaxis, X-ray, sealants, and fluoride supplementation if indicated.

 

7)         Home health services.

 

8)         Counseling and anticipatory guidance with referrals and follow-up as needed to child and/or parents as appropriate.

 

A)        Nutritional needs including food purchase and preparation, routine dietary needs, and the importance of a high quality diet.

 

B)        Automobile restraints for children and general injury prevention concepts (especially home injuries, unintentional poisoning, and sports injuries).

 

C)        Parenting skills, with specific appraisal to identify parents at risk of child abuse or neglect.

 

D)        Need for and importance of immunizations.

 

E)        Child care arrangements.

 

F)         Dangers of use by children and effects of parental use on children of smoking, smokeless tobacco, alcohol and other drugs as well as other risk-taking behavior.

 

G)        Physical activity and exercise.

 

H)        Dental health.

 

I)         Childhood antecedents of adult illness.

 

J)         Child development (including sexual maturation and adjustment, and developmental and behavioral difficulties).

 

K)        Environmental hazards.

 

L)        Using community health resources such as WIC, food stamps, welfare and social services that bear significantly on health status.

 

M)       Other relevant topics in response to child and/or parental concern.

 

9)         Counseling and provision of appropriate treatment services and/or referral to services (including Early Intervention Services for Infants and Toddlers, special education, services for crippled children, mental health services, home health and homemaker services) as needed for parents:

 

A)        who have health problems that seriously affect their capacity to care for the child.

 

B)        whose child is seriously ill.

 

C)        whose child has a chronic illness or handicapping condition, or a significant behavioral or emotional problem.

 

D)        whose child is or is about to be hospitalized.

 

b)         Local Health Nursing Follow-up for High-Risk Infants

 

1)         Purpose

The purpose of the infant follow-up program is to minimize disability in high-risk infants by identifying as early as possible conditions requiring further evaluation, diagnosis and treatment and by assuring an environment that will promote optimal growth and development.

 

2)         Agencies to Provide Services

 

A)        All Local Health Departments shall provide follow-up services to residents of their counties.

 

B)        The Department may contract with a local health agency to provide follow-up services to residents of areas without a Local Health Department.

 

3)         Eligibility for Services

Any infant eligible for the Adverse Pregnancy Outcomes Reporting System (APORS) and referred to a Local Health Department or other designated local health agency shall be offered follow-up services. The family may decline those services.

 

4)         Services To Be Provided

 

A)        A minimum of 6 visits shall be made by the follow-up nurse as soon as possible after newborn hospital discharge and at infant chronological ages 2, 6, 12, 18 and 24 months. Infants and their

families having actual or potential health problems identified by the nurse shall be visited more frequently for health monitoring, teaching, counseling and/or referral for appropriate services. Occasionally, when an infant is receiving services at the Local Health Department, a follow-up visit may be conducted by the nurse at that time.

 

B)        Follow-up services should include:

 

i)          Health history, including: prenatal and natal history; parental concerns; family history of genetic disease or unexplained mental retardation; compliance with medical regimen, if any, including medications, treatments and visits to the physician; infant care, including nutrition, elimination and sleep activity; and family/infant interaction, family coping and parental knowledge of injury prevention.

 

ii)         Physical assessment, developmental assessment, and age specific anticipatory guidance based on the American Congress of Obstetricians and Gynecologists guidelines or current recommendations of the State that are found in subsection (b)(5).

 

iii)        Based on the results of the health history and physical assessment, the nurse shall identify problems, make nursing diagnoses and arrange for intervention. Intervention may include: counseling the family as to the importance of regular primary health care by the family physician, pediatrician or clinic; encouraging scheduled return visits to the Perinatal Center; family teaching/counseling by the follow-up nurse; referral to the physician or other screening, diagnostic or support services depending on the nature of the problem; and follow-up on referrals.

 

5)         Local health agencies must adhere to the provisions of this Part and the Department's High Risk Infant Tracking Supplement for Local Health Departments, which may be obtained from the Department's Division of Community Health and Prevention.

 

c)         Access-Related Services

 

1)         Outreach services.

 

2)         Translator and 24-hour emergency telephone services.

 

3)         Child care services to facilitate obtaining needed health services.

 

4)         Availability of services for the handicapped.

 

5)         Transportation.

 

(Source:  Amended at 35 Ill. Reg. 452, effective December 22, 2010)

 

Section 630.60  Health Services For Adolescents

 

The Department of Public Health, through its Maternal and Child Health Program may allocate funds for programs providing health services for adolescents in accordance with American Academy of Pediatrics, American Congress of Obstetricians and Gynecologists and Centers for Disease Control and Prevention standards.  One or more of the following MCH services may be included in application proposals for Title V and State MCH Project grant funds.

 

a)         Services for adolescents.

 

1)         Periodic health assessment to include:

 

A)        Medical history and systems review (general medical and social, family and genetic background, with items of inquiry determined by age, sex, developmental stage, and likelihood of potential problems).

 

B)        Psychosocial history, including school progress and problems, out-of-school activities, peer and family relationships, and health-related habits, including sexual activity and use of alcohol and drugs.

 

C)        Complete physical examination to include:

 

i)          Height, weight, skin, head and neck, thorax, lungs, cardiovascular system, abdomen, genitalia, musculoskeletal system, nervous system, and mental status.

 

ii)         Sexual development.

 

iii)        Vision, hearing, and speech evaluations.

 

iv)        Blood pressure.

 

D)        Developmental and behavioral assessment.

 

E)        Screening and laboratory tests as indicated, including hemoglobin/hematocrit and tuberculin skin test (Mantoux) in children from high risk groups or in areas of high endemic rates of tuberculosis; and, for adolescents at risk, such procedures as lead poisoning, parasite, and sexually transmitted disease screening and pregnancy testing.

 

F)         Nutritional assessment and services and supplementation as needed.

 

2)         Maintenance of immunizations according to state and nationally recognized standards including those in Section 630.80(a)(5) of this Part.

 

3)         Family planning services with availability of extensive counseling for the adolescent, partner, and family as appropriate; and education on, among other topics, the importance of early prenatal care and risks to both mother and child of childbearing in early adolescence.

 

4)         Pregnancy Related Services as described in Section 630.30(b) for those who are pregnant.

 

5)         Diagnosis and treatment or referral and follow-up of general health problems, both acute and chronic.

 

6)         Diagnosis and treatment or referral and follow-up of mental health problems, both acute and chronic, including emotional and learning disorders, behavioral disorders, alcohol and drug related problems, and problems with family and peer group relationships.

 

7)         Counseling and provision of support services as needed to children with chronic illnesses and/or handicapping conditions.

 

8)         Dental services, both preventive and therapeutic, including oral examination, prophylaxis, X-ray, and fluoride supplementation if indicated.

 

9)         Home health services.

 

10)         Counseling and anticipatory guidance with referrals and follow-up as needed to the adolescent and/or parents as appropriate.

 

A)        Nutritional needs, including the importance of a high quality diet and the risks associated with fad diets.

 

B)        Automobile restraints and general injury prevention concepts, including sport injuries.

 

C)        Psychosomatic complaints such as those associated with family and school difficulties.

 

D)        Dental health.

 

E)        Smoking, smokeless tobacco, use of alcohol and other drugs.

 

F)         Physical activity, exercise, and sleep.

 

G)        Relationship of health-related behaviors in adolescent to adult illness.

 

H)        Sexual development and adjustment, sexual relationships, and family life.

 

I)         Future plans, including school and vocational plans.

 

J)         Using community health resources such as WIC, food stamps, welfare and social services that bear significantly on health status.

 

K)        Other topics in response to adolescent and/or family concern.

 

11)         Counseling and provision of appropriate treatment services and/or referral to services (including home health and homemaker services) as needed for parents:

 

A)        who have health problems that seriously affect their capacity to care for the adolescent.

 

B)        whose adolescent is seriously ill.

 

C)        whose adolescent has a chronic illness or handicapping condition, or a significant behavioral or emotional problem.

 

D)        whose adolescent is or is about to be hospitalized.

 

b)         Access-related services.

 

1)         Outreach services.

 

2)         Translator and 24-hour emergency telephone services.

 

3)         Child care to facilitate obtaining needed health services.

 

4)         Services available for the handicapped.

 

5)         Transportation.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.70  Definitions

 

"Administration" means those activities performed by staff and costs which are supportive of and required for the project for which there is no direct client contact such as administrative staff, clerical support, rent, utilities, postage, telephone, office supplies, fiscal staff and office equipment.

 

"Case Management" means a mechanism to coordinate and assure continuity of services (health, social, educational) necessary for clients. Case management involves individualized assessment of needs, planning of services, referral, monitoring and advocacy to assist a client in gaining access to appropriate services and closure when services are no longer required. Case management is an active and collaborative process involving a single qualified case manager, the client, the client's family, the providers and the community. This includes close coordination and involvement with all service providers in the management plan for that client and/or family including assuring that the client receives the services.

 

"Counseling" means the provision of advice, guidance or instruction on the part of a knowledgeable person with the goal of meeting specific needs of individuals or groups.

 

"Equipment" means any nonexpendable item with a unit cost equivalent to or greater than the State of Illinois' definition for equipment, State Finance Act [30 ILCS 105].

 

"Follow-up" means the process by which further services are rendered and/or the process by which an assessment is made concerning the outcome of an intervention plan of care or referral for further services.

 

"High Risk" means as defined in Section 640.20 of the Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640.20).

 

"Home health services" mean services such as the provision of medical, nursing, other therapeutic and rehabilitative services in the home; homemaker services including assistance for the family in routine household responsibilities when illness or disability interferes with such functions.

 

"Medical services" mean those activities dealing directly with the health care of the client such as physician services, nurse practitioner services, diagnostic tests, prescription drugs, medical supplies, clinic nurses, clinic interpreters and medical equipment.

 

"Nutrition services" mean services such as screening/assessment of nutritional status; dietary counseling to assist people to meet their normal and therapeutic nutrition needs; nutrition education and evaluation; and provision of, or referral to, resources needed to improve or maintain nutritional health, i.e., supplemental food assistance, special feeding equipment, and food service programs.

 

"Outreach" means any activity to find and inform potential program participants of available services.  Outreach, therefore, can include community campaigns as diverse as door-to-door canvassing, production and distribution of handbills, design and publication of newspaper announcements, and production and broadcast of public service announcements or paid advertising on radio or television.  The primary objective of outreach activities is to inform potential program participants of available services, eligibility criteria and method of accessing services (for example, the name, address and phone number of the provider).  This is not to preclude the use of nontraditional methods of outreach that may be necessary to identify potential participants in hard-to-reach populations, such as persons who abuse substances or engage in prostitution.

 

"Postpartum" means the period from the birth of the infant or termination of pregnancy and the succeeding 42 days.

 

"Prenatal" means the period of time existing from conception of the fetus until the birth of infant or termination of the pregnancy.

 

"Referral" means the process by which an individual is directed to a resource for further service, information, or assistance.

 

"Services for both acute and chronic health problems" mean services such as clinic and physician offices services, emergency services, laboratory and x-ray services, provision of prescribed drugs and vaccines, and medical supplies.

 

"Services for both acute and chronic mental health conditions" mean services such as clinic and physician office services, counseling and anticipatory guidance, crisis intervention services, laboratory services, and provision of prescribed drugs.

 

"Support Services" mean those activities which are supportive of patient care and in which patient contact occurs such as, public health nursing, health education, educational supplies, patient travel, social services, nutrition services and related staff travel.

 

(Source:  Amended at 15 Ill. Reg. 13874, effective September 27, 1991)

 

Section 630.80  Standards

 

The MCH Program is designed to assure provision of comprehensive medical care and continuity in the health management and supervision of care to meet the health needs of mothers, infants, and children.  Maintenance of standards prescribed herein and in the project plan may exceed state guidelines but may not be less, except as permitted by the Department.

 

a)         Personnel Staffing and Facilities

 

1)         The qualifications of each person employed by the Projects shall meet, as a minimum, the Illinois Merit System Standards.

 

2)         Each project shall have a full-time project director.  However, the state agency may give prior approval for the appointment of a project director who is employed less than full time where the state agency finds that such an appointment is consistent with the purposes of the program.  Situations in which this could be the case include, but are not limited to, areas in which there were not adequately trained persons available on a full-time basis or if a project's scope or focus was of such a limited nature that utilization of a full-time director would not be practical.

 

3)         Staffing for projects shall be reflective of the services to be provided; i.e., medical, dental, nursing, nutrition, social work, psychology, speech and hearing, physical therapy, and administration.  The extent of staffing in the projects shall depend upon the project size and availability of personnel.

 

4)         Project plans shall give assurance that the services will be provided by or supervised by qualified personnel.  Qualifications shall be determined by reference to a merit system, established minimum qualifications, occupational standards, state and local licensing laws and specialty board requirements.  Such standards, laws and requirements, shall be incorporated by reference in the application for a grant.

 

5)         Standards for each project shall meet state and local licensing laws and regulations and be in accord with national and state standards such as:

 

A)        Hospital Accreditation References The Joint Commission

 

B)        Hospital Care of Children and Youth

            American Academy of Pediatrics

 

C)        Guidelines for Perinatal Care

American Academy of Pediatrics

American Congress of Obstetricians and Gynecologists

March of Dimes

 

D)        Towards Improving the Outcome of Pregnancy

The National Foundation − March of Dimes Committee on Perinatal Health

 

E)        Standards for Obstetric − Gynecologic Services

American Congress of Obstetricians & Gynecologists

6^th edition 1985

 

F)         Standards of Child Health Care Council on Pediatric Practice American Academy of Pediatrics

 

G)        School Health:  A Guide for Health Professionals

American Academy of Pediatrics

 

H)        Standard of Maternal and Child Health Nursing Practice,

American Nurses Association

 

I)         A Statement on the Scope of Maternal and Child Health

Nursing Practice, ANA

 

J)         Standard of Practice for the Perinatal Nurse Specialist, ANA

 

K)        Standards of Community Health Nursing Practice, ANA

 

L)        Definition and Role of Public Health Nursing in the Delivery of Health Care, APHA.

 

6)         If a project is planned for an area in which it is not possible to meet these standards, the best available resources shall be used.  In such case, the application shall include a description of proposed remedial actions.

 

7)         Projects are encouraged to use outpatient and inpatient facilities appropriate to the needs of the area to be served.  Arrangements for provision of services must be made in advance of implementing the project. Special consideration shall be given to the provision of space for:  counseling to assure privacy and dignity for the patient; intake interviewing and physical examinations; the projected patient load giving consideration to waiting room, babysitting services, dental facilities, records, bathroom, laboratory and for other necessary services.  Space should assure privacy and efficient patient flow.

 

8)         Projects shall utilize authorized Perinatal Centers for hospitalization of high risk maternity and newborn patients, and specialty services recognized by the Division of Specialized Care for Children, when applicable.

 

b)         Nondiscrimination

 

1)         Projects are to be conducted in such a manner that no persons shall be excluded from participating in, be denied the benefits of, or be otherwise subjected to discrimination under such programs on the grounds of age, handicap, race, color, creed, religion, sex, or national origin pursuant to the provision of Title VI, Civil Rights Act of 1964, (42 U.S.C. 2000e et seq.); Age Discrimination Act of 1975 (42 U.S.C. 6101 et seq.); Rehabilitation Act of 1973 (29 U.S.C. 701 et seq.); Title IX of the Education Amendments of 1972 (20 U.S.C. 1681 et seq.).

 

2)         Affirmative action shall be taken to ensure equality of opportunity in all aspects of employment.

 

3)         Periodic reviews of operating procedures shall be made to assure that operating practice continues to be in conformity with the above requirements.

 

4)         Any person has the right to file a complaint with the Department, the U.S. Department of Health and Human Services, or both, if he believes that discrimination on the grounds of age, handicap, race, color, creed, religion, sex or national origin is being practiced.  If filed with the Department the complaint shall be routed to the Director's office where it shall be reviewed and investigated by a special committee appointed by the Director.  A report of final disposition shall be sent to the complainant and to the appropriate federal agency.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.90  Records

 

a)         Administrative.  The following administrative records shall be maintained by the project for a period of three years:

 

1)         All financial record of expenditures, third-party reimbursements and other project income.

 

2)         An inventory record of all equipment purchased from project funds including (listing shall be cumulative and updated annually):

 

A)        A description of the item.

 

B)        Inventory identification (I.D.) number.  This can be a manufacturer's serial number or other I.D. number, but it must be permanently affixed to the item.

 

C)        Acquisition date and cost.

 

D)        From whom purchased.

 

E)        Location and condition of the item.  No property can be disposed of without prior written authorization of the Chief, Division of Family Health. Upon termination of a project the equipment becomes the property of the Illinois Department of Public Health.

 

3)         Personnel records for all project staff.

 

4)         Statistical information derived from project activities.

 

b)         Patient Records

 

1)         One record containing the appropriate information relative to that person's care shall be maintained on each patient.

 

2)         A project record shall be maintained on each individual registered in the project.  The record should be designed to accommodate entries by each discipline providing services for that project.  Documentation showing preauthorization of services purchased by the project shall be maintained as a part of the individual's patient record.  All services provided to a particular patient by each discipline must be easily reviewable by the other disciplines.

 

3)         The record shall be useful as an administrative and health management tool.

 

4)         Confidentiality.  The following information relating to patients and persons requesting services shall be treated as confidential:

 

A)        Names and addresses individually or by list.

 

B)        Information contained in reports of medical examinations and treatments.

 

C)        Information about financial resources.

 

D)        Information contained in registers, in case records, correspondence, any forms or notations obtained from or about the individual and family concerning his condition or circumstances, including all such information whether or not it is recorded.

 

E)        Records of state and local health department evaluations of such information.

 

5)         Release of Information.  Information shall be kept confidential and shall not be divulged except as follows:

 

A)        Confidential information may be released only with the parent's or patient's consent to agencies, institutions or individuals who are requested to provide maternal and child health services to the mother or child, as a part of the program of the state agency.

 

B)        Confidential information may be released to other state or federal agencies having as their purpose the health and welfare of the mother or child for whom the patient or his parent, in his behalf, has requested services.  In these circumstances the information may be released only if adequate assurances are given that:

 

i)          The confidential character of the information will be preserved;

 

ii)         the confidential information will be used only for the purpose for which it is made available;

 

iii)        such proposals are reasonably related to the purposes of the program of the state or local agency and the functioning of the other agencies or programs; and

 

iv)        the standards  of protection established by the other agencies or programs to which the confidential information is made available are at least equal to those established by the state or local health department.

 

C)        When a signed consent form is received from the patient, confidential information must be released to the Department to evaluate the effectiveness of prenatal care, to conduct research to reduce infant and maternal morbidity and mortality, and to assist the Department in the allocation of resources.  For women who consent to collection of such data, the grantee will solely retain all identifying information of the women (name, address, social security number, phone number) and provide code numbers to the Department in place of such information.  The grantee will destroy the consent forms after the Department has completed its review of the data.  That consent form will include:

 

i)          the name of the person signing the form;

 

ii          the name and address of the patient;

 

iii)        a statement of consent to release information for the purposes stated in subsection (b)(5)(C) above;

 

iv)        a protection against release beyond the Illinois Department of Public Health.

 

D)        Information may be disclosed in summary, statistical or other form, which does not make it possible to identify any particular individual.

 

(Source:  Amended at 17 Ill. Reg. 3013, effective February 22, 1993)

 

Section 630.100  Reports

 

The following reports shall be submitted:

 

a)         Performance Reports

 

1)         Federal legislation (Title V, Social Security Act of 1935, 42 U.S.C. 701 et seq.) requires the State Maternal and Child Health Program to submit an Annual Program Performance Report no later than ninety days after the end of the grant period.  In order to comply with this requirement, the state agency must obtain an individual performance report from each MCH Project.

 

2)         As part of the funding agreement with the Illinois Department of Public Health, projects are required to submit quarterly performance reports within 30 days after the end of each quarter.  Annual performance reports are to be received in the Division of Family Health no later than 45 days after the end of the grant period.

 

3)         Annual performance reports shall address the following points:

 

A)        Comparison of the objectives enunciated in the approved project proposal with the actual achievements of the project.

 

B)        Indicators of project productivity; e.g., clients served, encounters, referrals, tests performed, personnel trained, etc.

 

C)        Scope and success of project outreach efforts.

 

D)        Unresolved problems; e.g., with fiscal resources, external relationships, etc. and issues which need to be addressed in the future.

 

4)         Quarterly performance reports shall address subsections (3)(A), (B), and (C) above.

 

5)         The grantee agency shall comply with all specific program reporting requirements identified within the contract signed by the grantee and the Illinois Department of Public Health.

 

6)         The original copy of this report shall be submitted to:

 

Division of Family Health

Program Administrator

Illinois Department of Public Health

535 West Jefferson Street

Springfield, Illinois 62761

 

b)         Expenditure reports (See 630.20(d)).

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.110  In-Service Training

 

a)         The staff of the state Maternal and Child Health program in cooperation with the local MCH project staff will conduct in-service training programs for project personnel. Staff involved in the delivery of client services are required to attend.

 

b)         Project staff are encouraged to attend and participate in appropriate educational programs of professional organizations.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.120  Evaluation

 

Projects will be evaluated at least annually by the state Maternal and Child Health staff and their designees to review the program's progress according to stated goals, measurable objectives and administrative operations.

 

Section 630.130  Use of Project Funds

 

a)         When approved in the plan and budget, funds may be used for the direct costs of operating and maintaining the project.  The following direct costs may be incurred:

 

1)         Salaries, including fringe benefits for full or part-time personnel employed for the project. The rates for personal services and fringe benefits shall be comparable to that paid to other employees of the agency.

 

2)         Fees for consultants and specialists.

 

3)         Travel of personnel, consultants, and specialists in carrying out the activities approved in the plan.  Reimbursement shall be made in accordance with established delegate agency policies.

 

4)         Transportation of patients at the usual rates for the mode of travel that is consistent with the needs of the patient.

 

5)         Supplies, including biologics, drugs, blood, oxygen, X-rays, laboratory services, etc., as required in the operation of the project.  The cost of supplies shall not exceed the lowest charge levels at which they are generally available in the area.

 

6)         Rental of privately owned facilities where adequate space cannot be provided by the grantee agency.  Rental charges shall not exceed the lowest rate for comparable space within the community as supported by bids.

 

7)         Purchase of outpatient care including services from other community resources such as homemaker, visiting nurses, etc. For all grantees whose projects provide for payment of medical care or appliances the grantee must provide these services at Healthcare and Family Services rates established pursuant to the Illinois Public Aid Code [305 ILCS 5] and must have assurance that the vendor accepts this as payment in full for financially eligible clients.

 

8)         Purchase of hospital inpatient care services for high risk women and infants, in designated perinatal centers.

 

9)         Equipment used in the operation of the project excluding the purchase of vehicles.

 

10)         Other expenditures directly related to the provision of project services such as telephone service, mimeographing, utilities, etc.  Purchases of items or services that do not vary significantly in quality from one supplier to another shall not exceed the lowest charge levels at which they are available in the area. A description for prorating costs must be provided.

 

b)         Indirect costs may be included as a portion of the overall project costs as defined in the Grant Accountability and Transparency Act (GATA) [30 ILCS 708/15] if the indirect costs are budgeted along with the direct costs.

 

c)         Project funds shall not be used to pay the following:

 

1)         Inpatient care services other than inpatient services provided to high risk women and infants and to crippled children, except when determined to be in the best interest of the projects by the Chief of the Division of Family Health.  Request must be in writing and approved in advance.

 

2)         Purchase, construction, or renovation of buildings.

 

3)         Dues to societies, organizations, or federations.

 

4)         Entertainment costs.

 

5)         Cash payments to intended recipients of health services.

 

6)         Abortions.

 

7)         Purchase or repair of vehicles.

 

8)         Lobbying.

 

9)         Any other costs not approved in the plan and budget.

 

d)         Administrative costs shall not exceed 15% of the total grant award. For grants requiring a medical component, that component should be at least 45% of grant award. Any deviation from this must be approved in writing by the Director of the Illinois Department of Public Health after a review of the circumstances which would require such an exception. The Department will consider the following in determining whether to grant an exception:  the nature of the project, ability to find resources in the community which will meet part of the needs of the project and thus invalidate the percentages, a targeting of the resources toward one particular component or identified unmet need by the grantee which clearly will inhibit the ability of the grantee to carry out the project.

 

(Source:  Amended at 41 Ill. Reg. 13633, effective October 26, 2017)

 

Section 630.140  Program Income

 

a)         Program income is defined as gross income earned by a delegate agency from activities which are performed as a result of that delegate agency having received a grant from the Illinois Department of Public Health.  It includes fees for services performed or proceeds from usage or rental fees or the sale of property.  Revenues received from taxes, levies, fines are not considered program income.

 

b)         All projects shall have agreements with the Illinois Department of Healthcare and Family Services' Medical Assistance Program for reimbursement of covered services for project patients who are Title XIX recipients.  Steps shall be taken to obtain reimbursement from non-profit, semiprivate, and private medical insurance programs, when these programs cover services rendered by these projects.

 

c)         Program income shall be retained by the delegate agency and included in the project budget.

 

d)         Each project may elect charge eligible recipients for certain services provided by the project; however, a flexible sliding fee scale must be utilized and included for approval in the project application process prior to any fees being charged.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.150  Eligibility for Services

 

a)         It is intended that persons receiving services through the projects be those who are financially unable to provide required medical care for themselves.

 

b)         Services shall be made available:

 

1)         Without any requirement for legal residence except that the patient is currently living in the area served by the program, or if outside by special permission of the project director.

 

2)         Upon referral from any source including the patient's own application.

 

3)         Without regard to age, handicap, sex, race, religion, nationality, ethnic background, or marital status.

 

4)         To certain categories of patient who reside outside the geographic area served by the project such as school age pregnant girls or migrants who may require and seek services rendered by the project.  Program patients who move to a neighborhood outside of the project's geographic boundary may continue in the project if the program director considers this in the patient's best interest.

 

5)         Documentation of spenddown or denial of Public Aid eligibility for reasons other than failure to comply with Public Aid processes must be maintained in the case file for covered services.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.160  Availability of Services

 

a)         Direct Services

 

1)         Consideration shall be given to the socioeconomic and cultural backgrounds of both children and their parents in developing a personalized approach to service delivery.

 

2)         All services provided directly by the projects shall be made available on a voluntary basis to all patients accepted into the program of care.

 

b)         Indirect Services and Authorization of Payment for Services

The projects may make provisions to arrange and pay for additional services needed by the eligible patient if they cannot be provided by the project and are required as part of the total care needed by the patient.

 

c)         Other Services

 

1)         Patients having medical conditions which are not related to the intended purpose of the projects shall be referred to appropriate sources of care (see Utilization of Community Resources 630.170).  Specialty programs of the Division of Services for Crippled Children are to be utilized wherever feasible, with no attempt on the part of the projects to duplicate these or other programs serving mothers and children.

 

2)         Transportation may be provided to needy project patients through public facilities where available, project operated buses, preauthorized taxi, ambulance services, or other preauthorized modes of transport. Rates of reimbursement shall be at the rate allowed by the agency.

 

3)         Special services such as baby sitting, housekeeping, nursing home care may be provided to eligible project clients.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.170  Utilization of Community Resources

 

It shall be the responsibility of each project director to coordinate the services provided through the project with other sources or care in the community, such as:

 

a)         The Illinois Medical Assistance Program.

 

b)         Local Health Departments.

 

c)         Neighborhood Health Centers.

 

d)         Local Child Development Clinics.

 

e)         Division of Services for Crippled Children.

 

f)         Local Hospitals.

 

g)         Local Children and Family Services Programs.

 

h)         Local Schools.

 

i)          Vocational Rehabilitation Services.

 

j)          Regional Perinatal Centers.

 

k)         Local Early Intervention Programs for Infants and Toddlers with Handicaps.

 

l)          Other related social service agencies.

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.180  Abortions and Sterilizations

 

a)         No Maternal and Child Health program funds shall be used to perform abortions except where the life of the mother would be endangered if the fetus were carried to term.  It is not, however, intended to prohibit projects from conducting medical procedures necessary for the termination of an ectopic pregnancy or for the treatment of rape or incest victims, nor is it intended to prohibit the use of drugs or devices to prevent implantation of fertilized ova.

 

b)         Surgical procedures for voluntary sterilization shall be provided or arranged and paid for in accordance with 42 CFR 50.201 (et seq.).

 

Section 630.190  Reasonable Cost

 

Reimbursements to hospitals shall not exceed the amount determined to be reasonable under Sec. 1861 (V) Social Security Act (42 U.S.C. 1395v) and in accordance with Sec. 1122 Social Security Act (42 U.S.C. 1320a) (nonapproved capital expenditures).

 

(Source:  Amended at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.200  Preparation of Applications

 

a)         Eligibility:

 

1)         All public or private agencies recognized by the Illinois Department of Public Health as possessing a demonstrated  capability of directing such projects are eligible for MCH Project Grants.

 

2)         The following varieties of program implementation are acceptable:

 

A)        Program implemented exclusively by the grantee agency;

 

B)        Program implemented by the grantee agency in association with another community agency or agencies:

 

C)        Program implemented by a community agency under contract to the grantee agency which maintains supervision and holds responsibility;

 

D)        Program implemented by several agencies on a coordinated regional basis.

 

3)         The General Assembly may, from time to time, appropriate state and federal funds for particular agencies or categories of agencies to provide MCH services, such as for local health departments to offer prenatal care services.

 

b)         Application Development:

All applicants are urged to discuss their interests and ideas for developing programs early in the planning stages with the Division of Family Health.  Applications may include one or more of the health service categories outlined in Sections 630.30 through 630.60.  Staff of the Division of Family Health are available to assist applicants in planning programs meeting these guidelines.  Applicants should refer to Sections 630.80 through 630.200 for further description of the standards for all MCH Projects.

 

c)         Project Narrative:

The narrative section of the project application or plan shall contain the following elements and must address each item listed below:

 

1)         Title of project.

 

2)         Problem:  The health and related problems or needs which the project will address shall be identified.

 

3)         Characteristics of the area:

 

A)        Program plans shall specify the geographic areas or political jurisdictions which are in need of services.  These can be census tracts, school districts, cities, counties, etc.; and should be areas with concentrations of low-income families.  Concentration does not necessarily refer to demographic factors, but to the proportion of low-income families to a defined population.

 

B)        Particular attention should be given to areas and census tracts in cities where maternal and child health services are inadequate due to overcrowding of facilities; where many women receive little or no care; and where maternal and infant mortality, morbidity, and prematurity rates are high, and the number of infant deaths is excessive.  Particular attention also should be given to rural areas and economically depressed areas where the needs of maternity and infant patients are not being met.

 

C)        Latest available demographic and other statistical and descriptive data on the area to be served shall be provided as applicable. Examples of such information include:

 

i)          population (sex, age, race and ethnic data should be included).

 

ii)         geography.

 

iii)        financial status/median income.

 

iv)        socioeconomic class.

 

v)         percent of public aid recipients.

 

vi)        population turnover (mobility).

 

vii)       prevalence of families with female head only.

 

viii)      birth rate:  overall, teenage; and out-of-wedlock.

 

ix)        maternal mortality.

 

x)         infant mortality.

 

xi)        morbidity and mortality through age 19.

 

xii)       distribution of medical and allied health services and personnel.

 

xiii)      other indicators of the overall health status of the community.

 

4)         Objectives:  Clearly stated measurable short-term (current grant year) and long-term objectives of the proposed project and a schedule for when they will be achieved shall be provided on the "Plans to Achieve Objective Form." Criteria for the successful achievement of each objective must be included as well as the source of information to be used to evaluate success.  The objectives shall be measurable and shall related to specific aspects of the program.

 

5)         Resources available:

 

A)        A description of the applicant agency's capability to conduct a program of the scope envisioned, describing the health and social service facilities, agencies, programs, etc., in the community and the proposed relationship of these resources to the program shall be provided.  Working letters of agreement signed by both parties shall be included in support of any referral arrangements.

 

B)        Services in outpatient and inpatient facilities, appropriate to the needs of the area to be served, shall be arranged for in advance of initiating program services.  Facilities shall be designed to expedite efficient patient flow, and to assure the privacy and dignity of the individual.

 

6)         Program operation:  Plans for program implementation and operation shall be described with regard to achieving stated program objectives.

 

A)        Patient load:  Estimates of the number of women, children and infants to be served by the program shall be included. This shall be provided separately for each category of service and group of clients to be served.

 

B)        Location of Services:  The locations and the types of services which will be provided by participating hospitals, clinics, private physicians, dentists, and other health and support resources shall be included.

 

C)        Description of Services:  The pediatric, maternal, family planning, dental and other services to be offered, with emphasis on those services which are not presently available to all segments of the community shall be described.

 

D)        Comprehensiveness:

 

i)          The program shall describe the comprehensive array of services necessary to assure optimal care within the service areas identified in the project, i.e., prenatal care, child health, adolescent health services, etc.  Provisions shall be made for the development of a care plan for each client that assures effective interdisciplinary provision of services.  Comprehensive means completeness to ensure that all needed services are available and integrated so that services are rendered in an orderly fashion, with an emphasis on assuring continuity of care.

 

ii)         Comprehensive health care includes not only physical examination and laboratory services but also nursing, social work, nutritional, dental and other health and support services as appropriate.

 

iii)        Standards and guidelines shall be developed so as to be specific for each group serviced using standards such as those outlined in Section 630.80.  Criteria for high risk classifications shall be included and shall be consistent with these references as well.

 

iv)        The patient care plan shall take into account utilization of other health care resources necessary to assure optimal, continuous and complete maternal and infant care.  Necessary arrangements for transportation, babysitting or homemaker services shall be described.  Written procedures shall be developed by the project to assure that necessary health care will be provided including working letters of agreement signed by all required parties.

 

E)        Intake procedures:  The intake procedures to be utilized i.e., appointments, walk-in combination, or other, including appropriate assurances that medical care and services will be delivered promptly shall be provided.

 

F)         Follow-up:  Program plans shall outline the specific procedures which will be implemented to assure adequate follow-up services.  Arrangements for follow-up services not directly rendered by the program should be described to assure that these recipients necessary services.

 

G)        Referral:  The patient care plan shall provide for utilization of other health care resources necessary to assure continuous and complete care. Written procedures shall be developed by the project to assure that necessary health care and support will be provided and that standard referral procedures will be followed.  Written agreements between agencies shall be developed and included with the application.

 

H)        Outreach:  Plans for outreach such as home visits; health education to individuals or groups, including community organizations and use of mass media shall be described.

 

7)         Organization:

 

A)        The administrative structure and staffing pattern of the program, including organization charts, job descriptions for all positions, and curricula vitae for core personnel shall be provided.

 

B)        Applicants shall give assurance that the services will be provided by or supervised by qualified personnel.  Qualifications shall be determined by reference to merit system, established minimum qualifications, occupational standards, state and local licensing laws and specialty board requirements. Such standards, laws and requirements, shall be incorporated by reference in the grant application. Copies of current licenses or certificates shall be maintained on file with the grantee.

 

C)        Copies of insurance coverages shall be maintained on file including malpractice coverage.

 

8)         Target group and eligibility requirements:

 

A)        Descriptions of the target population within the service area and how the services are designed especially for this group shall be included.

 

B)        Income standards for eligibility for services shall be 185 percent of the federal poverty guidelines (see 55 Fed. Reg. 5664, February 16, 1990). These are to be applied flexibly with due regard to family size and income and the family's other financial responsibilities in relation to the cost of required care.

 

C)        A schedule of rates of payment for services shall be included in the grant application and shall be made known to patients at the time of admission interview and be applied flexibly after approval by the Illinois Department of Public Health.  Approval will be based upon a cost analysis methodology which can be demonstrated to the Department.

 

D)        Estimates of the percentage of the population eligible for all categories of services shall be provided listing the criteria to be used in deciding who is to receive services.

 

E)        The project director or a member of the project staff designated by him shall determine patient eligibility by taking into account the criteria listed below.  Services shall be available:

 

i)          Without any requirement for legal residence except that the patient currently is living in the area served by the program.

 

ii)         Upon referral from any source including the patient's own application.

 

iii)        Without any requirement for court commitment as a prerequisite for any part of the care.

 

F)         The method proposed for authorizing services allowable under project policies shall be described in the project plan.  Authorization for services for which payments are made from project funds, shall be maintained by the grantee.  A form for each patient shall show the services authorized, and the amounts expended for the specific types of services approved.

 

G)        The grantee shall give assurance that:

 

i)          Services shall be available only to recipients because they are from low-income families or cannot access services for other reasons beyond their control.

 

ii)         Services shall be available to recipients from outside the project area only if approved by the project director.

 

iii)        Services shall be available to recipients who are not from low-income families only if such care does not reduce the delivery of necessary services to recipients from low-income families.

 

9)         Patient record system:  A description of procedures designed to insure that accurate and up-to-date health records will be initiated and maintained for each patient shall be included.  The records shall include a complete medical history, growth charts, results of each medical examination, screening procedures, laboratory tests, a summary of instructions given to patients or parents, a list of medications prescribed, and all relevant health, patient education, social services and environmental information.  Records shall be confidential.  With the patient's consent, copies of medical records may be furnished to hospitals or other health care providers.

 

10)       Evaluation of project activity:  The methods proposed for assessing the progress of the program toward meeting its stated objectives shall be described.

 

11)       Sub-contracts:  Arrangements with other agencies or health care providers who will deliver a portion of the projects's services, including copies of any contracts or agreements with outside providers shall be provided.

 

12)       Third-party Reimbursement and Other Sources of Funds:

 

A)        Additional program services may be furnished to larger numbers of patients by securing third-party reimbursement or other sources of funds. A project shall make every reasonable effort to collect from third-party sources (including government agencies) which are authorized or under legal obligation to make such payments.  Approval will be made by the Department when the income is budgeted into the project and meets the standards in subsection (c)(8)(B) of this Section.

 

B)        Patients, who would not otherwise receive services for reasons beyond their control, may receive and be charged for services only if the provision of such services does not reduce the delivery of necessary services to the low-income patients.  In those instances where charges are made for services provided to patients who are not from low-income families, such charges shall be applied flexibly with due regard to family size and income and the family's other financial responsibilities in relation to the cost of required care and shall be approved by IDPH before implementation.

 

13)       Regional and Local coordination:  

 

A)        In accordance with recommendations of the American Medical Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics, services for non-high risk as well as high risk mothers and infants shall be developed as a part of overall regional planning.  Such regional coordination may involve the crossing of state boundaries.

 

B)        When the provision of services or programs requires an advisory group composed of community representatives whose function is to make recommendations for awarding funds to subcontractors, membership shall be restricted to persons not having a fiduciary interest in, not serving in a policy making position for, and not working as a staff member for any applicant agency.

 

14)       Supporting data and additional information:  Additional relevant information to support the proposal shall be provided, including working letters of agreement from all participating agencies, pertinent letters of support and evidence of nonprofit status.

 

d)         Budget:

 

1)         All applicants shall submit a detailed budget proposal for each project period as part of the project application for new applicants or with the progress report and any proposed plan revision for continuing projects.  The budget proposal shall be submitted on forms provided by the Division of Family Health, and shall include all information and signatures required in the instructions.

 

2)         The budget is divided into major categories of cost.  Not all categories will apply to all projects.  In preparing its budget, each project should use only those budget categories applicable to its own operations.

 

3)         Budget categories are further divided into line items which specify the amounts for each item of expense allowable under the budget.

 

4)         In some agreements between the State Agency and the delegate agency as subgrantee, local funds supplement the project effort.  The local share may be in the form of cash contributions, or may be the "in kind" valuation placed upon goods, services, physical facilities, etc., directly benefiting or specifically identifiable to the grant supported activity.

 

e)         General Requirements and Assurances.  Each project grant application shall contain assurances in writing that:

 

1)         The grantee shall implement the program within three months of the date when authorization to proceed is given.  Funds for programs not implemented within three months shall revert to unawarded status, unless a written extension request is approved.

 

2)         For any program developed under the stated alternative method of implementation (See subsection (a)(3) of this Section), the grantee agency shall retain sole responsibility for program implementation and fiscal accountability.

 

3)         The grantee agency shall allow periodic on-site review of its programs and records including those of its subcontractors by the staff of the Division of Family Health or their authorized representatives.

 

4)         The grantee agency shall submit quarterly performance reports to the Division of Family Health within thirty (30) days of the end of each quarters. The final annual report is due within 45 days of the end of the project period. All other specified reports shall be submitted within identified time lines.

 

5)         Forms used to authorize services, for which payments are made from project funds shall be maintained by the grantee.  A form for each patient shall show the services authorized, date of authorization, and the amounts expended for the specific types of services authorized, date of authorization, and the amounts expended for the specific types of services approved.

 

6)         Payment for high risk inpatient hospital services perinatal centers designated in accordance with the Regionalized Perinatal Health Care Code (77 Ill. Adm. Code 640) shall be based on the lesser of reasonable cost of services (See Section 630.190) or the customary charges to the general public for such services.

 

7)         Grantees shall not amend the application for which the grant was approved without prior written permission from the Department.

 

8)         The applicant shall maintain adequate records to show the disposition of all grant funds expended for activities for which the grant was made. All records shall be retained for three years after the close of the fiscal year in which the grant was made and shall be made available for audit purposes upon request of the Department.

 

9)         Attention is called to the requirements of Title VI, Civil Rights Act of 1964, 42 U.S.C. 2000e et seq., the Age Discrimination Act of 1975, the Rehabilitation Act of 1973 and Title IX of the Education Amendments of 1972 which provide that no person in the United States shall, on the grounds of age, handicap, race, color, creed, religion, sex or national origin be excluded from participation in, be denied the benefits of, or be subject to discrimination under any program or activity receiving federal financial assistance.  All services provided by the applicant shall be made available without discrimination on the grounds of age, handicap, race, creed, religion, sex, marital status, national origin or duration of residence.  Professional liability insurance must be in place and on file for all personnel providing service.

 

10)       Grantees shall use grant funds in addition to, rather than in lieu of, existing local or other State or federal funds currently available for the purposes approved in the grant award.  Existing funds which are currently available are those which have been available at least during the budget period immediately preceding the period for which funds are being requested and will also be available during the period  for which the funds are being requested.

 

11)       Failure by the grantee to comply with these requirements, site review recommendations or grant conditions will be cause for discontinuance of funds or termination of the grant.

 

f)         Continuation Application:

 

1)         For continuation applications, an annual progress report, budget and an abbreviated narrative describing the service model for the upcoming fiscal year must be submitted.  Any proposed revisions to the project plan must be submitted in detail.  This must include projected caseloads, and updated objectives on prescribed forms.

 

2)         The annual progress report shall describe the accomplishments since the last annual progress report, and may include charts, graphs or tables in addition to the narrative report.  Progress shall be related to stated objectives.  Proposed revisions to the project plan shall be submitted as separate documents revising specific sections of the approved narrative.

 

g)         Revisions

 

1)         Any changes in the project narrative, objectives, caseload or budget must be submitted in writing to the Illinois Department of Public Health prior to implementing the change. All proposed changes must include a description of the change and justification for the change.  Budget revisions should specify the amount of dollars involved and the type of change.  When budgetary changes are requested revised budget pages shall be submitted.  Telephone requests for emergency changes will be considered individually.  Approved telephone requests must be followed by written documentation as described above prior to reimbursement.

 

2)         Grantees shall be notified in writing when revisions are required by the Division in any matter related to the administration of the projects including but not limited to changes in funding levels.

 

3)         There are three possible types of budget revisions:

 

A)        Adjustment − The total amount of the budget remains the same.  Funds are shifted within the budget between line items and/or budget categories.

 

B)        Supplement − The total amount of the budget is increased by adding funds to specific budget categories and line items, or by creating new line items.

 

C)        Reduction − The total amount of the budget is decreased by reducing or eliminating line items or budget categories.

 

h)         Termination

 

1)         All grants shall terminate on the dates specified in the contracts and shall not be extended or renewed except as provided for in Section 630.20(b)(1)(C).

 

2)         A grantee who has substantially failed to comply with this Part and the grant award as documented at site reviews for two consecutive years will have funding terminated. Substantial failure for the purpose of this Section shall mean failure to meet requirements other than a variance from the strict and literal performance which result in unimportant omissions or defects given the particular circumstances involved.  The grant contract may be terminated by either party upon a 30 day written notice.  Unallocated monies will be used to expand existing projects or to fund new projects in underserved areas.

 

3)         The Director, after notice and opportunity for hearing to the grantee, may suspend or terminate the grant in any case in which he/she finds that there is or has been a violation of this Part.

 

4)         Such notice shall be effected by registered mail, by certified mail, or by personal service setting forth the particular reasons for the proposed action and fixing a date, not less than 15 days from the date of such mailing or service, at which time the delegate shall be given an opportunity for a hearing. Such hearing shall be conducted by the Director or by an employee of the Department designated in writing by the Director as Hearing Officer to conduct the hearing. On the basis of any such hearing, or upon default of the delegate agency, the Director shall make a determination specifying the findings and conclusions. A copy of such determination shall be sent by registered mail, certified mail, or served personally upon the grantee. The decision shall become final 35 days after it is so mailed or served, unless the grantee, within such 35 day period, petitions for review pursuant to this Section.

 

5)         The procedure governing hearings authorized by this Part shall be in accordance with Rules of Practice and Procedure in Administrative Hearings (77 Ill. Adm. Code 100).

 

6)         If, however, the Department finds that:

 

A)        The public interest, including financial interest, health safety, or welfare requires emergency action (emergency action would result from such instances as, but not limited to, bankruptcy and/or insolvency, fraud, and financial instability), and;

 

B)        Unless the Department receives documentation that the grantee's assets are sufficient to meet the grantee's liabilities in the form of a certified financial statement, and;

 

C)        If the Director incorporates a finding to that effect in the order; then

 

D)        Summary suspension of the grant shall be ordered pending proceedings for termination or referral to State or federal authorities, which proceedings shall be instituted within one week of summary suspension and promptly determined.

 

7)         In no case where summary suspension has been ordered shall reimbursement be made to the delegate agency for costs incurred or funds expended after the date of summary suspension unless, after conclusion of the proceedings, such reimbursement or payment is ordered by the hearing officer, administrative law judge or court of competent jurisdiction.

 

(Source:  Amended at 17 Ill. Reg. 3013, effective February 22, 1993)

 

Section 630.210  Review under Administrative Review Law

 

Whenever the Department suspends or terminates a grant the grantee may have such decision judicially reviewed. The provisions of the Administrative Review Law [735 ILCS 5/Art. III] and the rules adopted pursuant thereto shall apply to and govern all proceedings for the judicial review of final administrative decisions of the Department hereunder.

 

(Source:  Added at 14 Ill. Reg. 11219, effective July 1, 1990)

 

Section 630.220  Outreach and Case Management

 

a)         Definitions.  Outreach and case management are defined in Section 630.70.

 

1)         "May" is used to indicate permitted outreach and case management activities.

 

2)         "Must" is used to indicate required outreach and case management activities.

 

3)         "Shall" is used to indicate required outreach and case management activities.

 

4)         "Should" is used to indicate recommended outreach and case management activities.

 

5)         "Advocacy" and "Advocate" mean that the case manager or case manager assistant will ensure, to the extent possible, that the participant receives needed services.

 

b)         Agency Requirements.

 

1)         Criteria for Certifying Agencies to Conduct Outreach and Case Management Activities.

 

A)        Grantees of the Illinois Department of Public Health conducting outreach and case management activities must apply for certification as a case management agency.  Certified agencies will enter into a written agreement with the Department or its designee to conduct these activities.

 

B)        Application Process for Certification as a Case Management Agency.

 

i)          The annual funding application must provide assurance that the applicant is in compliance with the requirements set forth in subsections (b)(2) and (3) and describe in detail how it will meet the program requirements set forth in subsection (b)(4) through (7) and describe in detail how it will provide services in accordance with the requirements set forth in subsection (c) through (f).  Further, the agency must agree on a continuous basis to comply with this Part and all applicable Federal and State laws and regulations.  (See Title XIX of the federal Social Security Act (42 U.S.C.A., Section 1396 et seq.) and the Illinois Public Aid Code [305 ILCS 5].

 

ii)         The Department or its designee will notify successful applicants in writing.  The Department or its designee shall provide technical assistance to applicants when requested.

 

C)        Certification.

 

i)          Provisional certification will be awarded for 180 days to successful applicants.  During this period, the Department or its designee will conduct a management and fiscal review to ensure compliance with these rules.  (See Section 630.20(e) and (f).)

 

ii)         Full certification will be awarded for two years to agencies who successfully complete the review conducted during provisional certification. During this period, the Department or its designee will conduct a management and fiscal review to ensure compliance with these rules.  Successful agencies (based on review findings) will be recertified for a two-year period. Unsuccessful agencies (based on review findings) will be given provisional certification.  The Department or its designee may, based on review, change an agency's certification at any time, or terminate certification, pursuant to Section 630.200(h).

 

2)         The agency must agree to help a program participant apply for benefits under the Medicaid program.

 

3)         Physical facilities to be used for serving participants must be comfortable, safe, and clean, and must meet local requirements for fire safety, building construction, sanitation and health.  The agency must be able to furnish proof upon request that all such local requirements have been met.  In addition, a space for meetings with participants that is conducive to privacy should be available.

 

4)         The agency must be capable of delivering services to the target population, demonstrate an understanding of the concept and delivery of case management services and demonstrate (by written agreements or other means such as letters of support) linkages to relevant service and health care agencies serving the target area.

 

5)         The agency must conduct outreach activities to the target population and medical providers in the geographic area to be served.

 

6)         Direct service staff for the program must meet the standards defined in subsection (c) and proof of licensure must be available upon request.

 

7)         The agency must be able to provide services in medical, home and other settings such as schools and churches.

 

8)         The agency must maintain an adequate and confidential participant records system.  Documentation of all services provided is to be maintained in this system.  (Refer to Section 630.90.)

 

c)         Provider Qualifications.

 

1)         The case manager must meet one of the following qualifications:

 

A)        a registered professional nurse licensed pursuant to Section 12 of the Nurse Practice Act [225 ILCS 65] and

 

i)          two years experience in community health or maternal and child health nursing, or

 

ii)         a Bachelor of Science in Nursing (B.S.N.) degree from a recognized or accredited program and one year of experience in community health or maternal and child health nursing, or

 

iii)        supervision by a registered professional nurse, licensed social worker or licensed clinical social worker with the length of experience described herein, until the case manager obtains the length of experience required in subsection (c)(1)(A)(i) or (c)(1)(A)(ii) of this Section.

 

B)        a clinical social worker licensed pursuant to Section 9 or social worker licensed pursuant to Section 9A of the Clinical Social Work and Social Work Practice Act [225 ILCS 20] and 68 Ill. Adm. Code 1470 and:

 

i)          one year of experience in providing services to families with young children, or

 

ii)         supervision by a registered professional nurse, licensed social worker or licensed clinical social worker with the length of experience described herein until the case manager obtains the length of experience required in subsection (c)(1)(B)(i) of this Section.

 

C)        possess a master's degree or baccalaureate degree in a behavioral science, social science or health-related area; or a baccalaureate degree in any other area and one year of experience in child, family or community services; or an associate degree and two years experience in child, family or community services.  Case managers meeting only this qualification must be supervised by a case manager meeting requirements of subsection (c)(1)(A) or (c)(1)(B) of this Section until they have a total of two years of supervised case management experience.

 

2)         Exception process:  The Department will use the following procedures when grantees' staff do not meet the qualifications listed above or when they are unable to recruit qualified staff.

 

A)        Individuals employed by a grantee, at the time of the adoption of this Section, to conduct case management activities as described in this Section will be deemed qualified.

 

B)        Grantees that can demonstrate an inability to recruit individuals who meet the qualifications listed above may request an exception.  The Department or its designee will grant an exception if it is requested in writing and documents:  the grantee's efforts to recruit qualified staff; the education and experience that the grantee proposes to require in filling the position; a justification of why the proposed education and experience are functionally equivalent to the above requirements; and a plan for bringing the individual into compliance within a two-year period.

 

3)         Case Manager Assistants.  Paraprofessionals and lay workers may be used to perform some case management functions under the supervision of the case manager.  These functions may include intake, follow-up with participants or providers to ensure that participants are accessing needed services, and provision of support and assistance that participants may require to access services.  The functions of assessment, service planning, referral, and reassessment of participant's needs are limited to the case manager. Paraprofessionals and lay workers may also be used to conduct outreach activities.

 

d)         Clinical record.  The participant's clinical record shall contain, but is not limited to:

 

1)         identifying information including name, case number, address and telephone number, sex, race, Hispanic origin, date of birth, marital status, and date of initial contact and initiation of case management services;

 

2)         documentation of the participant's eligibility status for all payment mechanisms for medical care;

 

3)         assessment and reassessment reports;

 

4)         an individual care plan, progress reviews and notes;

 

5)         documentation of missed appointments and attempts to follow up on missed appointments of those participants the case manager or physician have identified as noncompliant;

 

6)         documentation of each service rendered by the case manager as described in subsection (e);

 

7)         documentation of participant's authorization of the case manager to release information to providers of necessary services; and

 

8)         documentation of the participant's primary care provider.

 

e)         Case Management Process

 

1)         Role of the Case Manager.  One goal of the case management process is to help participants or their caregivers learn to accept responsibility for their own lifestyle and promote their own health.  Another major goal of case management is to enhance the participants' or their caregivers' strengths and resources by teaching them skills for seeking out and using individuals and agencies in the community who are available to meet a wide variety of human needs.  At first, the case manager will likely be responsible for most of these activities.  As time passes, the participants or their caregivers will ideally participate more actively, while the case manager adopts a more supportive role.  Successful case management relies on the education of participants, facilitation of access to services, coordination with service agencies, follow-up on services delivered, assistance with scheduling, and case management assessments to determine medical, psychosocial and environmental risks. The case management process includes the following activities:

 

A)        assessment of needed health and social services;

 

B)        development of an Individual Care Plan consistent with subsection (e)(2);

 

C)        referral of participants to appropriate providers within the community for services identified in the Individual Care Plan;

 

D)        on-going follow-up with participants or service providers to determine whether participants have accessed services.  Follow-up should be continuous from initial identification through case closure;

 

E)        periodic reassessment of participants' needs, as described in these rules;

 

F)         advocacy to assist participants in accessing services;

 

G)        procedures for terminating the professional relationship between the participant and the case manager when the participant no longer requires case management;

 

H)        case management activities should be provided during a face-to-face contact with the program participant whenever possible; and

 

I)         case managers may also perform outreach activities on a less than full-time basis.

 

2)         Individual Care Plan.  The case manager should utilize the recommendations from the primary care provider, other service providers as appropriate, and from the initial social and nutritional assessments to develop an individual care plan with each participant.  Development of the individualized care plan may include discussions with other providers identified in the plan (provided that the participant has consented in writing to such discussions); and telephone calls to, face-to-face meetings with, or home visits to the participant.  The individual care plan or clinical record must include, but is not limited to, the following:

 

A)        verification of eligibility status for all payment mechanisms for medical services;

 

B)        referral, if necessary, for physician services;

 

C)        a list of all of the service providers involved with the participant;

 

D)        a list of the agencies to which the participant will be referred;

 

E)        a problem list and plans for problem resolution;

 

F)         an assessment or assessments to determine the need for health, mental health, social, educational, vocational, substance abuse treatment, child care, transportation or other services, including:

 

i)          a nutritional assessment (refer to Sections 630.30(b)(3)(F), 630.40(b)(1)(E), 630.50(a)(1)(F), and 630.60(a)(1)(F));

 

ii)         a psychosocial assessment, including composition of family, evidence of parent-child bonding, parenting skills and education of parents;

 

iii)        support systems available to parents or caregivers;

 

iv)        social and health services currently used by the family, including sources of primary care and emergency care;

 

v)         environmental assessment, including at least the condition of housing, availability of utilities (water, heat, light, cooking, refrigeration, sanitation, etc.) and risks of unintentional injury; and

 

vi)        developmental assessment of infants and children.

 

3)         Assignment of Participants.  Each participating family should be assigned to one case manager.

 

4)         Frequency.  The case management agency must have face-to-face contact with the participating family as specified below and have as much additional contact as necessary to facilitate the family's access to services.  Each contact must include the activities described in Section 630.220(e)(6).  Whenever possible, the face-to-face contact should be made by the assigned case manager.  In determining the appropriate frequency of face-to-face contacts with a family, priority must be given to the requirements for infants, then for pregnant women, then for all other family members.

 

A)        For families with one or more infants, face-to-face contact at approximately two, four, six and twelve months of age.

 

B)        For families with a pregnant woman, face-to-face contact once each trimester of pregnancy.

 

C)        For families with one or more children over age one year, but without an infant or pregnant woman, face-to-face contact once each twelve months of program participation.

 

5)         Referral and Advocacy.  The case manager shall assure that any necessary referrals are made and advocate as necessary on the participant's behalf for services identified in the individual care plan.

 

6)         Follow-up and Reassessment.  Subsequent case management activities shall include, as necessary, a review of the implementation of the individualized care plan to date.  The case manager should update the individual care plan using any additional information received from the physician or other service providers.

 

7)         High-Risk Case Management

 

A)        Content.  High-risk case management includes all the service components of case management, including a review of the implementation of the individualized care plan to date, emphasizing compliance with recommendations regarding the high-risk condition(s).  High-risk case management must be performed by the case manager.

 

B)        Frequency.  High-risk case management may be provided as frequently as needed.

 

C)        Eligibility.  High-risk case management may be provided when the participant is determined to be at high risk for medical complications by the primary care provider or by risk assessment.  High-risk case management of infants and children may be provided by the case management agency when the infant or child has been identified through the Adverse Pregnancy Outcome Reporting System (APORS) (See 410 ILCS 525/3) and 77 Ill. Adm. Code 840.210), when the infant has been diagnosed with a serious medical condition after newborn discharge, when maternal alcohol or drug addiction has been diagnosed or when child abuse or neglect has been indicated based on investigation by the Illinois Department of Children and Family Services.  Similarly, APORS infants or children whose conditions are minor and whose environments are stable may be transferred into the low-risk follow-up regime.

 

8)         Home Visits.  Case management activities shall be conducted in the participant's home as presented below.

 

A)        At least once prenatally.

 

B)        At least once during infancy, if a home visit was not completed during pregnancy.

 

C)        At least once every 24 months of program participation to families that do not include a pregnant woman or an infant.

 

9)         Case Closure:

 

A)        Criteria for closure.  Unless other family members are receiving case management, case closure may occur when:

 

i)          the participant no longer meets age or income eligibility criteria for case management funding;

 

ii)         the participant moves out of the grantee's service area;

 

iii)        the participant dies; or

 

iv)        the case management agency is no longer able to reach the participant.

 

B)        Content.  At the time of closure, the case manager should ensure that the following activities have been completed, as appropriate for the participant's circumstances:

 

i)          the participant has located a medical care provider for continued care for himself or herself and his or her children;

 

ii)         the participant is referred for family planning services;

 

iii)        the participant is referred for postpartum WIC or Commodity Supplemental Food Program (CSFP) certification;

 

iv)        the participant's children are referred for WIC or CSFP certification;

 

v)         the children have begun or been referred for immunizations (if these are not contraindicated or declined by the parent);

 

vi)        the participant has completed application for Medicaid for his or her children; and

 

vii)       the participant has been given information regarding child restraint seats.

 

C)        If the participant is moving to another area, the participant's case records may be transferred to the new case management agency if the participant's consent is obtained.

 

f)         Case Management Coordination.  Department grantees providing case management services should engage in activities (as described below) to coordinate with other agencies in the grantee's service area that provide case management services to the same types of persons as the grantee has agreed to serve.  These activities are intended to avoid duplication of case management services at the local level and ensure that each participant has only one lead case manager at any given time.

 

1)         The case management agency should ensure that every family enrolled in case management continues to utilize primary medical care, regardless of the lead case management agency working with the family.

 

2)         Case Management Coordination Agreements.  Grantees of the Department's Division of Family Health should enter into written agreements with other agencies with the same geographic service area (in whole or in part) and with comparable scope of case management activities regarding coordination of case management services.  These agreements must at least specify each grantee's target group for services; referral procedures; procedures to obtain informed consent for services and protection of participant's privacy; and procedures to determine the agency most appropriate to provide case management services.

 

3)         Determination of the Agency or Program most appropriate for the delivery of case management services.  Following the assessments of a participant's service needs, the case manager, other involved service providers, and the participant (and the participant's parent(s) or legal guardian(s), depending upon the participant's ability to consent for services) should determine the one agency or program most appropriate to take a lead role in providing case management services if any of the criteria listed below are met.  Only those providers for which the participant has given written consent may participate in the determination of the most appropriate agency or program to provide case management.  The criteria requiring such a determination are:

 

A)        the participant's most important problem requires expertise for case management that the grantee's staff does not possess;

 

B)        the participant's most important problem requires expertise for case management that another agency's staff does possess;

 

C)        the participant's problems are so complex as to require the close collaboration of several agencies for successful case management; and

 

D)        the participant prefers to obtain case management services from another agency.

 

g)         Allowable Cost for Outreach and Case Management Activities.

 

1)         Federal financial participation in outreach and case management is provided through the Medicaid program for coordination of medical and medically-related services for the health and well-being of the participant.

 

2)         Allowable Costs for Outreach.  Costs incurred for outreach activities as defined in Section 630.70 are allowed.  However, health, general education, or other social service activities may not be included as outreach.

 

3)         Allowable Costs for Case Management.  Salary and other expenses for staff conducting outreach and case management activities must be supported by documentation, as described in subsection (h).  Expenses incurred for the provision of any other direct service (including patient teaching) by staff conducting outreach and case management activities must be excluded.  If program staff provide other direct services in addition to outreach and case management, the grantee's time and activity reporting system must distinguish between allowable and excluded costs.

 

4)         The agency must make its clinical and time reporting records available for inspection by authorized representatives of the Department, the Illinois Department of Public Aid and the Centers for Medicare and Medicaid Services.

 

h)         Time and Activity Data to be Collected.  The following time, activity and participant information must be recorded by each outreach worker, case manager and case manager assistant on his or her daily activities and the participants served.  Specific data entry codes for each item will be specified by the Department.  Each report must be signed by the outreach worker, case manager or case manager assistant making the report, and signed or stamped by the outreach worker's, case manager's or case manager assistant's supervisor.  A time study must be performed each quarter of the State fiscal year for at least one pay period or ten working days, whichever is longer.  The time study period for each quarter will be specified by the Department and communicated to the case management agency in writing.   During the remainder of each quarter of the State fiscal year, each case manager, case manager assistant or outreach worker must record and report only the information specified in subsection (h)(1), (h)(2), (h)(3), (h)(4), (h)(5)(A), (h)(5)(B), (h)(7), (h)(8), (h)(9), (h)(10), (h)(11) and (h)(12). This requirement applies to case management agencies that are serving clients who do not reside in the service area for the Medicaid Managed Care Demonstration program implemented by the Illinois Department of Public Aid under a waiver from the U.S. Centers for Medicare and Medicaid Services.

 

1)         Identification of the agency conducting the outreach or case management activity.

 

2)         Identification of the staff person conducting the outreach or case management activity.

 

3)         The date on which the activity was conducted.

 

4)         The Medicaid Case Identification Number and the Medicaid Recipient Identification Number.  These numbers are assigned by the Illinois Department of Healthcare and Family Services.  These numbers must be recorded if the participant's medical care is being paid for through the Medicaid program.

 

5)         Activity.  This item describes the outreach worker's, case manager's or case manager assistant's activity.  At a minimum, categories must identify case management; outreach; administration of outreach and case management; accrued benefit time; and other direct services, as follows:

 

A)        intake interview, assessment or reassessment of participant's needs; development or revision of the Individual Care Plan; referral or advocacy for services; follow-up with the participant or the provider's case closure; and travel;

 

B)        outreach/case finding;

 

C)        administration of outreach and case management activities.  This includes administrative activities not attributable to a specific client such as the development of monthly or annual program plans or budgets; planning project activities; developing linkage agreements or referral arrangements with community service providers; supervision of staff; preparation of routine correspondence; preparation of travel vouchers, telephone logs and similar activity records (except case notes and client tracking); staff supervision; and preparation of case notes and reports;

 

D)        staff training and evaluation.  Time spent in continuing education, in-service or other training programs, and time spent in performance evaluation;

 

E)        accrued benefit time (sick leave, vacation, compensatory time, etc.);

 

F)         health education.  Time spent directly providing health education to the participant;

 

G)        counseling.  Time spent directly providing counseling to the participant; and

 

H)        other direct services to participants not involving outreach or case management.

 

6)         Time Spent.  The amount of time spent on each activity.

 

7)         Case Number.  The participant's case number assigned by the Department's Case Management Information System or other software provided by the Department for this purpose.

 

8)         Participant's name.

 

9)         Medicaid Status.  The participant's eligibility status for the Medicaid program.  At a minimum, the participant must be classified as:

 

A)        ineligible.  This includes participants who are ineligible for the Medicaid program; or

 

B)        active.  The participant is eligible for the Medicaid program at the time case management activities are conducted; or

 

C)        the participant is in the process of applying for the Medicaid program. This includes discussing the participant's potential eligibility for Medicaid, as well as assistance provided while the participant's Medicaid application is pending; or

 

D)        "Healthy Start" (Medicaid Presumptive Eligibility) − The participant has been presumed eligible for the Medicaid Program by an agency qualified to make that determination; or

 

E)        Spend-down.  The participant has been placed on spend-down status by the Illinois Department of Healthcare and Family Services as defined in 89 Ill. Adm. Code 120.60(d) and 120.384.

 

10)         Program.  The grant program or programs through which the participant is receiving case management.

 

11)         Case Type.  The participant's eligibility for case management on the basis of age or pregnancy.

 

12)         Site of Contact.  Where the contact between the case manager and the participant or provider occurred.  At a minimum, this must be classified as:  the participant's home; the case manager's office; or off site, including transporting participants.

 

13)         Method of Contact.  How contact between the case manager and the participant or provider occurred.  At a minimum, this must be classified as:  individual, face-to-face contact; group contact; telephone contact; home visit; or unsuccessful home visit.

 

14)         Service.  Describes the predominant service provided to, discussed with, or arranged for a participant during a specific activity.  At a minimum, the following services must be recorded as appropriate:

 

A)        Services covered by the Illinois Medicaid Plan.

 

B)        Services not covered by the Illinois Medicaid Plan.

 

15)         Whether a referral was made, refused or not possible for needed service.

 

16)         The agency to which the participant was referred for a needed service.

 

17)         The date on which the referral for a needed service was completed.

 

i)          Agency Staff Expenses to be Reported.  The following information must be reported by each agency applying, provisionally certified or certified under subsection (b).  The information must be provided on a monthly basis, and the report must be signed and dated by an authorized official of the agency.  This requirement applies to case management agencies that are serving clients who do not reside in the service area for the Medicaid Managed Care Demonstration Program implemented by the Illinois Department of Healthcare and Family Services under a waiver from the U.S. Centers for Medicare and Medicaid Services. The information must include:

 

1)         The name, actual gross pay and actual paid hours for each full or part-time direct service staff person conducting outreach or case management activities;

 

2)         the full-time equivalence as agency employees for the direct services staff;

 

3)         the name, actual gross pay and proportion of time spent on the case management grant programs for each clerical, secretarial or other staff person supporting the direct service staff;

 

4)         the name and actual gross pay for the staff who supervise direct service staff full time;

 

5)         the name and actual gross pay for agency administrative staff;

 

6)         the length of the agency's regular workday (in hours);

 

7)         the agency's fringe benefit rate; and

 

8)         the total number of full-time equivalent agency employees.

 

j)          Agency Operating Expenses to be Reported.  The following actual operational expenses for the entire agency which is applying, provisionally certified or certified to conduct outreach and case management activities under subsection (b) must be reported.  This data must be submitted on a monthly basis, and the report signed and dated by an authorized official of the agency. This requirement applies to case management agencies that are serving clients who do not reside in the service area for the Medicaid Managed Care Demonstration Program implemented by the Illinois Department of Healthcare and Family Services under a waiver from the U.S. Centers for Medicare and Medicaid Services. Operating expenses must include the following:

 

1)         Rent;

 

2)         Maintenance;

 

3)         Utilities;

 

4)         Telephone;

 

5)         Photocopying;

 

6)         Office Supplies;

 

7)         Postage;

 

8)         Insurance;

 

9)         Dues, Subscriptions and Registration Fees;

 

10)         Travel;

 

11)         Depreciation on Building;

 

12)         Equipment;

 

13)         Depreciation on Equipment;

 

14)         Contractual Services; and

 

15)         The total of items listed in subsections (j)(1) through (j)(14).

 

(Source:  Amended at 18 Ill. Reg. 4384, effective March 5, 1994)

Section 630.APPENDIX A   MCH Grant Proposal Review Form

 

MCH Grant Proposal Review Form

Division of Family Health

New Applicant

 

Grant Title:

Proposal Submitted by:

(Agency Name)

Rating:  In each of the following categories please rate the proposal according to the information provided in the written submission, with five being high and one being low; circle the desired rating.

Category

Rating

I.

Merit of this proposal in addressing the purpose and criteria for the grant (refer to scope and standard of services in the Rules and Regulations).

1

2

3

4

5

a.

Narratives

b.

Objectives

c.

Resources/Program Operation

d.

Comprehensiveness

e.

Target Group/Eligibility

f.

Budget (general review only)

II.

Ability of the agency to provide services at a comprehensive single site or adequately coordinate these services with other community agencies. This should include staff capabilities (or capabilities to hire appropriate staff), physical facilities and fiscal management capabilities.

1

2

3

4

5

III.

Level of community support for project and maximum use of other funding sources.

1

2

3

4

5

IV.

General Comments:

a.

b.

Overall score of this application

 

– 2 –

V.

Conditions of Award if Funded:

Signed:

Dated:

MCH Grant Proposal Review Form Division of Family Health Continuation Application

Grant Title:

Proposal Submitted by:

(Agency Name)

Amount of Assistance Requested in this Application:

Current Fiscal Year Funding Level:

Ratings: In each of the following categories please rate the proposal according to the information provided in the written submission in the performance report with five being high and one being low; circle the desired rating.

Category

Rating

I.

Previous performance based on materials provided by program administrator (site review and summary of previous statistics and fiscal data).

1

2

3

4

5

II.

Merit of this proposal in addressing the purpose and criteria for the grant (Scope and standard of services described in the Rules and Regulations).

1

2

3

4

5

III.

Reevaluation of need for services within the area of service (refer to Rules and Regulations).

1

2

3

4

5

General Comments:

I.

Are there particular strengths or weaknesses in the proposal? Please elaborate:

II.

Does this proposed budget need revision or further explanations? Please elaborate:

Summary:

I.

Overall rank of of continuation grants in this category reviewed by this reviewer.

II.

Overall score for this continuation application

III.

Stipulations (if any):

IV.

Recommended grant award of $      .

Signed:

Date:

 

(Source:  Added at 14 Ill. Reg. 11219, effective July 1, 1990)

Section 630.APPENDIX B   Illinois Department of Public Health Reimbursement Certification Form

 

ILLINOIS DEPARTMENT OF PUBLIC HEALTH REIMBURSEMENT CERTIFICATION FORM
								page		of
AGENCY NAME:					PROGRAM:
ADDRESS:					CONTRACT #:
FEIN NUMBER:					BILLING PERIOD:
					DATE SUMITTED:
NAME/ VENDOR		TITLE/ PUR- POSE	PERIOD /DATE INCURRED	VOUCHER /CHECK #	GROSS AMOUNT	AMOUNT CLAIMED FROM IDPH	Agency Match/ WIC Admin		Nutrition Education
CERTIFICATION:					TOTAL
I hereby certify that the goods and/or services claimed above are necessary expenditures for the program and are a part of the approved budget, that appropriate purchasing procedures have been followed and that payment has not previously been requested or received.
Authorized Agency Official

 

(Source:  Added at 14 Ill. Reg. 11219, effective July 1, 1990)

Section 630.APPENDIX C   Instructions for Completing Reimbursement Certification Form

 

		August 1987
IDPH – OFFICE OF HEALTH SERVICES
Instructions for Completing the Reimbursement Certification Form
Agency Name:	Fill in your agency's name, address and FEIN (Federal Employer's Identification Number or in the case of Local Health Departments, the Comptroller assigned County Identification Number) as it appears in the contract/grant agreement.
Program:	Fill in the name of the Department program for which you are requesting reimbursement.
Contract   #:	Fill in the contract number (located in the upper right hand corner of the executed contract/grant agreement).
Billing Period:	Fill in the period covered by the request. The period shown should include the earliest date goods/services were ordered through the latest date services were provided. This period will be used by Department staff to determine proper state, federal and/or project fiscal year. You must submit separate Reimbursement Certification Forms for different state, federal and/or project fiscal years. If you have questions, please consult with Department program or fiscal staff.
Date Submitted:	Fill in date Reimbursement Certification Form is completed or sent to IDPH.
Name/Vendor:	Enter the name of the employee, business or other payee to whom payment was made.
Title/Purpose:	For payroll, enter the title of the employee; for other items, briefly describe the goods or services purchased. (Please provide enough information so that program staff can determine appropriateness to program).

 

Period/Date: Incurred:	For payroll, enter the period covered; for other items, enter the date the goods or services were received. In the case of supplies, equipment and other specific deliverables, it is a good idea to also note the date the order was made. This will assist program/fiscal staff to determine the proper state and/or federal fiscal year to be charged. This is required for all supplies and equipment received in lapse periods (after the end of the state or federal fiscal year).
Page  –2–
Voucher/Check Number:	Enter the voucher or check number for the payment. This establishes the audit trail and is necessary to verify that payment has been made.
Gross Amount:	Enter the total amount of the check identified previously or for payrolls the gross pay for the employee.
Amount Claimed from IDPH:	Enter the amount applicable to the program for which this Reimbursement Certification Form applies and for which you are requesting reimbursement.
Agency Match/ WIC Admin.:	For those programs which require the agency to provide matching support of Department expenditures, enter the amount of agency supplied match in this column. In most cases this will be a part of the difference between the Gross Amount column and the Amount Claimed from IDPH.   For the WIC program, each agency must identify the allocation of expenditures to either WIC Administration or Nutrition Education.  Since there is no matching requirement for WIC, the last two columns are to be used to show this allocation.
To further assist Department Program/fiscal staff, please list reimbursements by line item and show a sub-total for each line item.   In many cases, multiple pages will be necessary. In order to save some paper/copying charges, both sides of the Reimbursement Certification Form may be used. Please show the TOTAL on the final page only.   After review and approval, the authorized agency official shall sign the certification (only the final page which shows the TOTAL needs to be signed).   Forward the original and three copies of the Reimbursement Certification Form to:   Illinois Department of Public Health Office of Health Services, Fiscal Operations Unit 535 West Jefferson, 2nd Floor Springfield, IL  62761   The Office of the State Comptroller no longer requires vendors to sign or otherwise certify to expenditures on the State of Illinois Invoice-Voucher, Form C-13; therefore, the Reimbursement Certification Form is all that is required to be submitted. The Department fiscal staff will complete the C-13 using information from your Reimbursement Certification Form.

 

 

SD/dm
8/12/87
ILLINOIS DEPARTMENT OF PUBLIC HEALTH REIMBURSEMENT CERTIFICATION FORM
								Page 1 of 1
AGENCY NAME: Sangamon County Health Department				PROGRAM:   WIC
ADDRESS: 1234 West Fifth Street				CONTRACT #:   87G30027
				BILLING PERIOD:    7/1/87 – 7/15/87 DATE SUBMITTED: 7/22/87
FEIN NUMBER:  20-0000167
NAME/VENDOR			TITLE/PURPOSE			PERIOD/DATE INCURRED	VOUCHER/ CHECK #
Mary Jones			Nurse			7/1/87-	Payroll
Sally Smith			Nutritionist			7/15/87	Voucher
Tim Johnson			Nutritionist				#2378
Nancy Adams			Clerk
Betty Clark			Clerk
Wanda Campbell			WIC Administrator
Subtotal, Personal Services
Sangamon County Treasurer			Social Security, Pension Medical Insurance			7/1/87- 7/15/87	278976
Davis Supply Co.			Office Supplies			7/6/87	278834
Capitol Paper Co.			Paper Stock			7/10/87	278894
Subtotal, Supplies
Tim Johnson			Travel			7/1/87- 7/15/87	278975
GROSS AMOUNT		AMOUNT CLAIMED FROM IDPH			Agency Match/ WIC Admin		Nutrition Education
1,145.50		572.75			477.25		95.50
1,200.00		1,200.00			300.00		900.00
1,200.00		900.00			300.00		600.00
500.00		500.00			500.00
550.00		412.50			412.50
1,400.00		1,400.00			1,150.00		250.00
		4,985.25			3,139.75		1,845.50
15,728.56		1,096.75			690.75		406.00
327.57		86.40			86.40
250.00		250.00			200.00		50.00
		336.40			286.40		50.00
377.82		162.37					162.37
TOTAL		6,580.77			4,116.90		2,463.87
CERTIFICATION
I hereby certify that the goods and/or services claimed above are necessary expenditures for the program and are a part of the approved budget, that appropriate purchasing procedures have been followed and that payment has not previously been requested or received.
	Authorized Agency Official

 

(Source:  Added at 14 Ill. Reg. 11219, effective July 1, 1990)

Section 630.APPENDIX D   Plans to Achieve Objectives

 

PLANS TO ACHIEVE OBJECTIVES

Agency

Staff

Projected Period

Objective

Schedule

Tasks to Meet Objective

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Status of Tasks as of

 

(Source:  Added at 14 Ill. Reg. 11219, effective July 1, 1990)

Section 630.APPENDIX E   Application and Plan for Public Health

 

ILLINOIS DEPARTMENT OF PUBLIC HEALTH 535 WEST JEFFERSON STREET SPRINGFIELD, ILLINOIS 62761   APPLICATION AND PLAN FOR PUBLIC HEALTH PROGRAM GRANT

1.

PROGRAM TITLE: BRIEF SUMMARY:

2.

APPLICATION ORGANIZATION:

NAME:

ADRESS:

TELEPHONE:

(___)

FEIN NUMBER:

PROJECT DIRECTOR:

FINANCE OFFICER:

3.

APPLICANT CERTIFICATION:

To the best of my knowledge, the data and statements in this application are true and correct. The applicant agrees to comply with all State/Federal statutes and Rules/Regulations applicable to the program

AUTHORIZED OFFICIAL:

Date

Signature

4.

TYPE OF ORGANIZATION:

LOCAL HEALTH DEPARTMENT

PRIVATE NON-PROFIT AGENCY

OTHER

5.

GRANT SUPPORT REQUESTED:

BEGINNING

ENDING

AMOUNT

6.

TYPE OF APPLICATION:

INITIAL

CONTINUATION

REVISION

7.

LEGISLATIVE DISTRICT:

CONGRESSIONAL

LEGISLATIVE

(State Senate)

REPRESENTATIVE

(State Representative)

8.

DATE OF SUBMISSION:

Month

Date

Year

9.

IMPORTANT NOTICE:

This state agency is requesting disclosure of information that is necessary to accomplish the statutory purpose as outlined under 30 ILCS 105. Failure to provide this information may prevent this form from being processed. This form has been approved by the Forms Management Center.

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

APPLICATION AND PLAN FOR PUBLIC HEALTH  PROGRAM GRANT

PROGRAM NARRATIVE OR PROGRESS REPORT

INSTRUCTIONS:  Please complete a narrative in accordance with the instructions found in "Rules and Regulations" for the specific project for which you are requesting funds. If this is a continuation application, please use this page as a progress report in accordance with instructions in the "Rules and Regulations". Following the narrative, please attach a listing of all sites of service and their addresses for this project.

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

APPLICATION AND PLAN FOR PUBLIC HEALTH  PROGRAM GRANT

DATE FROM:

THROUGH:

SUMMARY BUDGET FOR THIS PERIOD

SOURCE OF FUNDS

Budget Total For Program

Applicant And Other

Amount Assistance Requested

1.

PERSONAL SERVICES

2.

CONTRACTUAL SERVICES

3.

SUPPLIES

4.

TRAVEL

5.

PATIENT CARE

6.

EQUIPMENT

7.

TOTAL DIRECT COSTS

SOURCE OF FUNDS – APPLICANT &

CODE

MATCHING OR COST

OTHER

OTHER CATEGORY ONLY

PARTICIPATION

REQUIREMENTS

$

$

TOTAL

$

$

USE ADDITIONAL SHEETS IF NECESSARY

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

APPLICATION AND PLAN FOR PUBLIC HEALTH  PROGRAM GRANT

DATE FROM:11219 THROUGH:

DETAILED BUDGET FOR THIS PERIOD (TOTAL COST)

MONTHLY SALARY RATE

NUMBERMONTHS BUDGET- ED

PER- CENT TIME

BUDGET TOTAL FOR PROGRAM

C O APPLICANT D AND OTHER E

SOURCE OF FUNDS AMOUNT ASSISTANCE REQUESTED

(1)

(2)

(3)

(4)

(5)

(6)

1.

PERSONAL

SERVICES

(Position Title & Name of Incumbent)

FRINGE BENEFITS

(Rate                          )

CATEGORY TOTAL

USE ADDITIONAL SHEETS IF NECESSARY

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

APPLICATION AND PLAN FOR PUBLIC HEALTH  PROGRAM GRANT

DATE FROM:

THROUGH:

DETAILED BUDGET

BUDGET TOTAL

C

APPLICANT

AMOUNT

FOR THIS PERIOD:

FOR

O

AND

ASSISTANCE

PROGRAM

D

OTHER

REQUESTED

(3)

E

(4)

(5)

2.

CONTRACTUAL SERVICES:

Itemize

CATEGORY TOTAL

$

$

$

3.

SUPPLIES

Itemize

CATEGORY TOTAL

$

$

$

4.

TRAVEL: Itemize

Mileage (Rate per mile:      ¢) Lodging Meals/Per Diem Commercial Transportation Other:

CATEGORY TOTAL

$

$

$

USE ADDITIONAL SHEETS IF NECESSARY

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

APPLICATION AND PLAN FOR PUBLIC HEALTH  PROGRAM GRANT

DATE FROM:

THROUGH:

DETAILED BUDGET

BUDGET TOTAL

C

APPLICANT

AMOUNT

FOR THIS PERIOD:

FOR

O

AND

ASSISTANCE

PROGRAM

D

OTHER

REQUESTED

(3)

E

(4)

(5)

5.

PATIENT CARE:

Itemize

CATEGORY TOTAL

$

$

$

6.

EQUIPMENT

Itemize

CATEGORY TOTAL

$

$

$

7.

TOTAL COSTS

$

$

$

USE ADDITIONAL SHEETS IF NECESSARY

ILLINOIS DEPARTMEN OF PUBLIC HEALTH

APPLICATION AND PLAN FOR HEALTH SERVICES GRANT

DATE FROM:11219THROUGH:

BUDGET JUSTIFICATION

INSTRUCTIONS:

Show justification for specific items or categories listed in the detailed budget for which the need is not self-evident. Justifications should clearly indicate that the times being requested are essential to the achievement of the stated project objectives and the conduct of the proposed procedures.

USE ADDITIONAL SHEET IF NECESSARY

 

(Source:  Added at 14 Ill. Reg. 11219, effective July 1, 1990)