Please direct all program related information and questions to:
Susan E. Williams
815 East Monroe
Springfield, IL 62701
The purpose of this agreement is to maintain a health care delivery system of Initial Health Screenings sites, Comprehensive Health Evaluation sites, primary care physicians and specialty care providers for children in the legal care and custody of the Illinois Department of Children and Family Services (DCFS) and who are in substitute care in the area to be served by the Lead Agency.
II. Policies & Procedures
Maternal and Child Health Services Code, 77 Illinois Administrative Code 630 (77 Ill. Adm. Code 630)
III. Contract and Amendment Process Contract Process
The contract between the Department of Human Services (hereinafter referred to as the "Department") and the Provider is generally referred to as the "Provider" in this Agreement and consists of several parts:
- Community Service Agreement, containing the standard contract language used for all Department contracts
- Exhibit A, containing Scope of Services/Purpose of Grant
- Exhibit B, containing Deliverables
- Exhibit C, containing Payment Information
- Exhibit D, containing Contact Information
- Attachment E
- The Program Manual, attached by reference to the Agreement, contains the program service provisions.
The Department will initiate the contract by having it online for the Provider to obtain and sign. The Provider will fax signature page to the Department to obtain the Secretary's signature and the Department will return a copy of the executed signature page of the contract to the Provider via pdf email.
There are two types of amendments to an executed Community Service Agreement.
- Letters of increase or decrease - A letter is sent to the Provider stating the intent to increase or decrease dollars to specific program services existing in the Community Service Agreement. There is no need for the Provider to sign and return this document.
- Formal amendments - A two-party signed agreement to an executed Agreement is a formal amendment. The following process is required for a formal amendment to be processed:
- Adding new program services - An amendment to add a new program service must contain a detailed summary of services to be provided under the executed Community Services Agreement and a method of payment.
- Extending the service dates of the Community Services Agreement* - An amendment to extend the service dates of the Community Services Agreement must contain the following information: Agreement number as it appears on the original Community Services Agreement; Provider name; clause stating the new term of the Agreement; signatures of the Provider and the Secretary of the Department of Human Services.
*NOTE: A Community Services Agreement end date should only be June 30 due to mandates in the State Finance Act regarding audit period. Language on pages one through nine in the Community Services Agreement may not be changed.
- Extending the service dates of an existing program attachment - An amendment to extend the date of a specific attachment in the existing Community Services Agreement must contain the following information: - Agreement number as it appears on the original Community Services Agreement; Provider name; clause stating the new term and the specific attachment name and number; signatures of the Provider and the Secretary of the Department of Human Services.
- Changing language within an existing program attachment - An amendment to change language in an existing program attachment of the Community Services Agreement must contain the following information: - Agreement number as it appears on the Community Services Agreement; Provider name; clause(s) stating the new language; signatures of the Provider and the Secretary of the Department of Human Services.
- Payments to the Provider will be made on a prospective basis, rounded to the nearest $100.00. The final prospective payment may be greater or lesser than the previous payments due to rounding.
- The Department will compare the amount of the prospective payments made to date with the documented expenditures provided to the Department by the Provider. In the event the documented services provided by the Provider do not justify the level of award being provided to the Provider, future payments may be withheld or reduced until such time as the services documentation provided by the Provider equals the amounts previously paid to the Provider. Failure of the Provider to provide timely documentation may result in a reduction to the total award.
- The final payment from the Department under this Agreement shall be made upon the Department's determination that all requirements under this Agreement have been completed, which determination shall not be unreasonably withheld. Such final payment will be subject to adjustment after the completion of a review of the Provider's records as provided in the Agreement.
V. Provider Responsibilities
The Lead Agency will make all reasonable efforts to maintain a health care delivery system of Initial Health Screening sites, Comprehensive Health Evaluation sites, primary care physicians and specialty care providers for children in the legal care and custody of the Illinois Department of Children and Family Services (DCFS) and who are placed in substitute care in the area to be served by the Lead Agency. The health care system to be developed and maintained shall, to the maximum extent possible, ensure DCFS Wards have timely access to essential health care services according to the periodicity schedule, or annually, whichever is more frequent, and standards of the federal Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Program. The most recent edition of "HealthWorks of Illinois Medical Case Management Handbook" (hereinafter referred to as the "Handbook") published by the Illinois Department of Children and Family Services is fully incorporated herein by reference.
- "All Reasonable Efforts" -- all actions which were made or could reasonably be made by the Lead Agency or a Sub-Provider in order to achieve a specified outcome or result. The standard of "All Reasonable Efforts" applies to all work and performance standards which are described and, therefore, the term "All Reasonable Efforts" is not generally repeated hereafter when describing work of the Lead Agency.
- "DCFS Ward" -- a child under the legal care and custody of the Illinois Department of Children and Family Services and who is placed in substitute care.
- "EPSDT" -- the Early and Periodic Screening, Diagnosis and Treatment Program as specified and defined in Title XIX of Social Security Act.
- "Essential Health Care Services" -- health care services, the type, frequency and quality of which meets the standards of the federal Medicaid EPSDT Program and include annual physical exams for all DCFS clients above the age of two years.
- "Medical Case Management Agency" -- an organization which has been designated by the Department to provide Medical Case Management under the Family Case Management program.
- "Primary Care Provider(s)" -- the duly licensed or credentialed physicians who are enrolled with the Illinois Medicaid program, who meet Family Case Management standards and who the Lead Agency has verified are willing to provide Essential Health Care Services to DCFS Wards, including documentation on DCFS forms of health services provided.
- "SACWIS" -- STATEWIDE AUTOMATED CHILD WELFARE INFORMATION SYSTEM is the DCFS information system for use by child welfare workers and the HealthWorks Lead Agency.
- "Sub-Provider" -- an entity which the Lead Agency has retained, only with prior written Department approval, to perform some portion of the Lead Agency's duties under this Program Plan.
- "Sub-Provider Territory" -- geographic subdivision of the Lead Agency's Territory, if any, for which the Lead Agency enters into subcontract to provide covered Services.
Population To Be Served
- The population of DCFS Wards to be served under this Attachment includes all children who at any time during the term of this Attachment are legally in the care and custody of the DCFS and who are placed in a substitute care living arrangement which is physically located in the Lead Agency's Territory.
- No DCFS Ward meeting the above definition may be excluded from receiving the health care services to be provided by the system of health services which the Lead Agency shall develop and maintain, as specified in this Attachment.
- Moreover, the Lead Agency and Medical Case Management Agencies (for children age birth through five years, pregnant Wards and children of parenting Wards) shall provide HealthWorks services to DCFS Wards who reside in any of the following living arrangements: Delegated Relative Authority (DRA), Foster Homes (FHA, FHB, FHI, FHP, FHS), Home of Relative (HMR), Group Homes (GRH), Hospital/Health Facilities (HHF), Independent Living (ILO), Institutions (ICF, IPA, IRS -- DCFS, Private Child Care Facility, Rehabilitation Services), Youth Emergency Shelters (YES), Job Training Program (JTP), Transitional Living Program (TLP), and Youth in Employment Program (YIE). However, DCFS is still responsible for ensuring that DCFS Wards who reside in other living arrangements are receiving essential health care services.
- Both parties acknowledge, however, that the circumstances of an individual DCFS Ward may create a situation which will make it impossible for the Lead Agency to ensure the DCFS Ward has timely access to essential health care services, despite the best efforts of the Provider or any Sub-Provider. In such situations, the Lead Agency may request permission in writing from DCFS to exclude an individual DCFS Ward from inclusion in the target population. Such request must state specifically the reasons why the Lead Agency cannot ensure the provision of health care services to a DCFS Ward and any recommendations the Lead Agency may have for alternative methods for the provision of essential health care services to the DCFS Ward.
Services to be Provided
The following services shall be provided by the Lead Agency or may be contracted through a certified Medical Case Management Agency:
- Interim Medical Case Management - The Lead Agency shall provide interim medical case management to all older DCFS Wards (age six through 20 years) in the Lead Agency's service area, through the first 45 days of custody. Interim medical case management for all younger DCFS wards (under 6 years of age) is provided by the Medical Case Management Agency. Critical Interim Medical Case management activities include: gathering of child and family health information; initiation of requests for prior health records; selection of primary care physician; completion of the Comprehensive Health Evaluation with 21 days of DCFS temporary custody; providing the Health Passport to the caregiver. Interim medical case management is to ensure HealthWorks enrollment, that is, selection of a HealthWorks Primary Care Physician. Documentation of the completed Comprehensive Health Evaluation, other accompanying health records, and prior medical records received must be sent to the caseworker within 30 days of custody for inclusion in the Client Service Plan that is submitted to the court. Any additional material received before the end of the 45-day Interim Medical Case Management period shall be faxed to the caseworker within two (2) business days of its receipt. Any material received by the Lead Agency after the 45-day period shall be sent to the child's caseworker (and medical case manager if under age 6) within three (3) business days of receipt and a copy kept on file. All appropriate information, which would include at a minimum the date and provider of the Initial Health Screening; the date, provider, other scheduling information, results, and recommendations of the Comprehensive Health Evaluation; selection of the primary care physician, must be entered into SACWIS for all Interim Medical Case Management eligible wards.
- Initial Health Screening System - The Lead Agency shall maintain an initial health care screening network which is capable of ensuring that all children entering DCFS custody receive an initial health screening prior to their initial placement, but no later than 24 hours after DCFS assumes protective custody of a DCFS Ward and has provided such notice to the Lead Agency. To accommodate the need to secure pre-placement screenings for DCFS Wards who enter care after hours, some parts of this network must provide for the availability of Primary Care Providers to conduct initial health screenings on a 24-hour, 365 days a year basis. The initial health screening shall be an unclothed physical examination to identify and treat as medically appropriate immediate health needs, document child abuse and neglect, identify communicable and contagious disease, provide medical information for informed placement and any necessary immediate referrals, and meet defined documentation and reporting requirements. The initial health screening network must have a sufficient number of physical sites to ensure DCFS staff who assume custody of a child will have to travel no more than 60 minutes to reach an initial health screening site capable of providing pre-placement health screenings on a 24 hours per day, 365 days per year basis. Additionally, the Lead Agency shall ensure that an initial health screening will be received, on average, within 60 minutes of arrival at the initial health screening site. The Department shall make available to the Lead Agency such data as may be needed by the Lead Agency to determine the number and locations of initial health screening sites which are needed. The Department shall also provide the Lead Agency with the medical protocols to be used by primary care providers performing the initial health screenings.
- HealthWorks Primary Care Physician Network - The Lead Agency shall recruit and maintain a network of primary care physicians (e.g., pediatricians, family practitioners, etc.). These physicians shall meet Maternal Child Health Primary Care Provider (MCHPCP) standards, document health care in the DCFS Medical Record Forms, and complete the Physician Practice Profile. The network of health care providers must be sufficient in number, skill level, and geographic accessibility to allow each Ward to receive all necessary preventive, routine, and acute care services.
- HealthWorks Enrollment - Primary Care Physician Selection and Documentation The Lead Agency shall ensure that all Wards in Lead Agency's area of responsibility are enrolled in HealthWorks. Enrollment in HealthWorks is defined as the selection of a primary care physician by the caregiver or DCFS ward her/himself or the identification of a primary care physician by the caregiver or eligible ward her/himself. The Lead Agency shall maintain records and keep current the name and address of the primary care physician selected by the substitute care giver or Ward for all eligible DCFS Wards in Lead Agency's area in SACWIS.
- Comprehensive Health Evaluation Provider Network - The Lead Agency shall maintain a Comprehensive Health Evaluation network of selected qualified medical providers which is capable of ensuring that all children newly taken into DCFS custody receive a Comprehensive Health Evaluation within 21 days of temporary custody. The Comprehensive Health Evaluation will meet the requirements of the EPSDT program and other components required by DCFS. The network will have a sufficient number of providers distributed throughout the Lead Agency's Territory so that a DCFS Ward will generally not have to travel more than 60 minutes to reach a Comprehensive Health Evaluation provider's work location. The Department shall make available to the Lead Agency such information as may be needed by the Lead Agency to make decisions concerning the number, location, capacity and capabilities of providers in the network.
- Comprehensive Services for All Children in Target Population - The Lead Agency will maintain a health care delivery system which has both the capacity and the capability to provide comprehensive EPSDT Program health care services to all currently enrolled DCFS Wards residing in the Provider's Territory. The Lead Agency will ensure that DCFS wards who meet the DCFS criteria for risk factors for HIV testing receive HIV testing. The Provider will also request and receive results of HIV testing and report positive test results to the DCFS AIDS Project Office.
- Specialty Health Care Services - The Lead Agency shall establish and maintain a network of specialty health care providers which has sufficient capacity to ensure DCFS Wards have timely access to specialty health care services as needed. The Lead Agency agrees that the specialty health care services network will include, but not necessarily be limited to, the following services:
- dental services;
- optometric services;
- hearing services;
- obstetric and gynecology services;
- University of Illinois, Division of Specialized Care for Children (DSCC) specialized services; and
- such other specialty health care services as may be needed by a DCFS Ward, except that such services are limited to those services covered by the Illinois Medicaid Plan as approved by the Centers for Medicare and Medicaid Services (CMS).
- Exception to the Geographical Distribution of Primary and Specialty Health Care Providers Requirement - If the Lead Agency is not able to recruit and organize a network of primary care physicians and specialty health care providers which is geographically distributed throughout the Lead Agency's territory to meet the travel time requirements stated above, the Lead Agency shall, in writing, notify the Department of:
- the areas of the Lead Agency's territory in which the travel time requirements cannot be met;
- the type(s) of health care service(s) that is not available; and
- the Lead Agency's plan for ensuring DCFS Wards have access to such service(s).
Additional Lead Agency Responsibilities
- Development of and Training on System Procedures
- The Lead Agency and the Department agree to jointly develop and maintain written procedures for the Lead Agency, primary care providers, the Department, DCFS, Purchase of Service (POS) agency staff, and substitute caregivers which shall inform such persons of the specific actions which are required of each category of persons to ensure DCFS Wards receive timely access to services.
- The Lead Agency and the Department agree to cooperatively develop and implement an initial and on-going training, education and communication program to ensure the Lead Agency's staff, initial health screening sites, Comprehensive Health Evaluation sites, primary care providers, DCFS, POS agency staff, and substitute care givers are informed of procedures for accessing essential health care services.
- The Lead Agency shall attend and participate in Foster Pride Training when offered in their county area. If Lead Agency staff cannot attend the training, the Lead Agency will be responsible for finding a representative within their Lead Agency Network to attend the training.
- Verification of Primary Care Provider Participation - The Lead Agency shall develop a system to verify the agreement of all participating primary care providers to provide and document in the DCFS Medical Record Forms health care services to DCFS Wards and to provide such verification to the Department upon request.
- Freedom of Choice of Primary Care Providers - The Lead Agency shall develop and operate a system for providing substitute care givers with the maximum level of freedom of choice of primary care providers for a DCFS Ward in the care of the substitute care giver.
- Primary Care Provider Assignment System - The Lead Agency shall enter into SACWIS the name and address of the primary care provider selected by each DCFS Ward or their substitute caregiver.
- Recruitment of Non-HealthWorks Physicians - The Lead Agency shall recruit all physicians referred by the substitute caregiver, medical case manager or the child's caseworker, etc. The recruitment process must begin within ten (10) business days of receipt of physician's name.
- Documentation of Health Care Services:
- The Lead Agency agrees to ensure primary care providers document health care services on the DCFS medical records forms.
- The Lead Agency agrees to distribute the required forms, formats, etc. to primary care providers in a timely fashion, with the forms, formats, etc. to be furnished to the provider in necessary quantities by the Department at no cost to the Provider.
- The Lead Agency will obtain the HealthWorks copy of the DCFS Medical Record Forms for the Comprehensive Health Evaluation, Age Appropriate Exams, Referrals, Screenings, and Acute Care within five (5) business days after receipt of services.
- The Lead Agency will maintain a central file of all health records received for Wards of all ages.
- The Lead Agency will ensure the Medical Case Management Agency and the Ward's caseworker have copies of all DCFS medical records within three business days after receipt of the documentation of services from healthcare provider.
- Ombuds Service
- The Lead Agency shall establish and implement an Ombuds service to receive and resolve in a timely manner any and all problems reported to the Lead Agency concerning access to essential services.
- The issues raised and the resolution of those issues shall be shared with the Department and the DCFS Downstate Health Services Manager each quarter.
- Quality Assurance - Customer Satisfaction Survey
- Upon receipt from the Department, the Lead Agency will implement a Department approved Customer Satisfaction Survey.
- The Lead Agency will distribute this survey to Eligible Wards, Substitute Caregivers, DCFS/POS staff, primary care providers, and IHS and CHE providers.
- The results will be compiled by the Lead Agency and submitted to the Department together with the individual survey instruments.
- Documentation and Tracking for Wards Age 6 and Older After the Interim Case Management Period
- The Lead Agency shall update information on the current primary care physicians for the DCFS wards in SACWIS
- The Lead Agency agrees to make all reasonable efforts to obtain and update such information in SACWIS.
- Assessment and Monitoring of Medical Case Management Agency(ies) or Sub- Provider(s)
- The Lead Agency shall meet with the medical case management agency(ies) or sub-provider(s) in the Lead Agency's territory at least quarterly to monitor, review, and discuss compliance with the Health Care System/Lead Agency performance standards specified in Section V. of the HealthWorks Health Care Network Agreement.
- The Lead Agency should utilize the information contained in the Cornerstone Client Summary Report and Client Status Report for the Lead Agency's territory as part of this ongoing assessment and monitoring responsibility.
- The Lead Agency and sub-provider agrees to achieve the specified outcomes or results described in Section V. of the HealthWorks Health Care Network Agreement.
The Lead Agency shall furnish the following reports to the Department or DCFS as designated below with respect to health care services provided for DCFS Wards. The reports shall be prepared in a format established by and acceptable to the Department. The reports shall be provided in a timely manner, as may be required by the Department.
- Expenditure documentation forms (EDF) - to the Department \
- HWIL Training Attendance form to be provided at the end of each training session, and Summary form provided as needed-to DCFS; and
- Provider Practice Profile Summary Report - to the Department
- Initial Health Screening Site Report - to the Department
- Comprehensive Health Evaluation Network Report - to DCFS
The Lead Agency shall report any unresolved issues concerning system coordination or access to essential services using the DCFS Issue Notification form. DCFS and the Department shall review these issues periodically to develop recommendations, if appropriate, for resolutions.
Approval and Ownership of Written Materials
- The Lead Agency shall not distribute any written materials under this Attachment unless and until the Department has approved such materials in writing. Any and all such materials shall be considered the sole property of the Department. All such materials shall include the name "HealthWorks of Illinois" and the following description: "HealthWorks of Illinois is a collaborative effort of the Illinois Departments of Children and Family Services, Healthcare and Family Services, and Human Services to provide comprehensive health services to children in the custody of the Department of Children and Family Services."
- Any materials pertaining to Medicaid billing procedures must be approved by the Illinois Department of Healthcare and Family Services.
Other Health Care System Characteristics
- The Lead Agency shall, in addition to the requirements of Section 'Services to be Provided', Subsections A - H, and "Additional Lead Agency Responsibilities", Subsections A - K" make all reasonable efforts to ensure the primary care physician network consistently has the following characteristics:
- hospital admitting services;
- 24-hour access to physician consultation and medical care to DCFS Wards;
- Availability of appointments for DCFS Wards for routine or primary health care within fourteen (14) days of any request from the caregiver of a DCFS Ward or the DCFS Ward her/himself.
Primary Care Providers' Qualifications
- The Lead Agency will ensure that all primary care providers are enrolled in good standing in the Illinois Medicaid Program, are enrolled in good standing as providers in the Family Case Management Program, will submit claims to the Illinois Department of Healthcare and Family Services (IDHFS) for all Medicaid-covered services provided to children, will accept reimbursement from IDHFS as payment in full for all such Medicaid-covered services, will provide health care services in a manner consistent with recognized standards of professional practice, and will document the provision of health care services as described in Section V. "Provider Responsibilities" Subsection "Additional Lead Agency Responsibilities" Subsection F. "Documentation of Health Care Services," above.
- The Lead Agency will ensure providers of primary health care or obstetric services are Board certified or Board eligible.
- All primary care providers must agree to comply with the provision of the Illinois Abused and Neglected Child Reporting Act concerning reporting of suspected abuse or neglect of a child and must agree to document essential health care services provided to DCFS Wards on such forms as may be required by the Department, including the DCFS HealthWorks standardized forms.
Payment for Completion of Documentation for the Comprehensive Health Evaluation
- The Lead Agency shall provide a payment of $15.00 to primary care providers for completing the documentation for the Comprehensive Health Evaluation for each DCFS Ward.
- This Agreement includes funds for the $15 payment to each Primary Care Provider who completes the documentation for the Comprehensive Health Evaluation for each DCFS Ward. The Lead Agency shall document and account for such payments in such a manner as to permit the Department to easily verify and audit such payments.
- This Agreement does NOT include funds for payment to agencies which provide medical case management to DCFS Wards at rates established by the Illinois Department of Healthcare and Family Services for such services.
Health Care System/Lead Agency Performance Standards
The goal of the health care system is to ensure 100% of DCFS Wards residing in the Lead Agency's Territory have timely access to a Primary Care Provider and essential health care services. The Department and the Lead Agency and any Sub-Provider will make all reasonable efforts to meet this goal and maintain such access. However, the parties recognize that there may be legitimate reasons which will cause some children to not receive scheduled health care.
- The Lead Agency agrees to fulfill the following responsibilities:
- Develop and maintain an adequate network of initial health screening sites that are available 24 hours a day, seven (7) days a week to ensure that all children entering DCFS custody receive an initial health screening.
- At least 90% of the initial health screenings are initiated within one (1) hour of arrival at the site and that the initial health screening documentation is completed by the provider.
- Develop and maintain a network of physicians who meet MCHPCP standards for access to a primary care provider and essential health care services.
- At least 95% of all new DCFS Eligible Wards who are listed on the DCFS Lead Agency New Ward report and reside within the Lead Agency's Territory select, within 21 days of custody, a HealthWorks primary care physician and receive a Comprehensive Health Evaluation. Where available, Comprehensive Health Evaluation sites shall be used for scheduling all Comprehensive Health Evaluations. The Comprehensive Health Evaluation must be documented on the Comprehensive Health Profile Form for those done at CHE sites or the DCFS Comprehensive Health History Form (CFS652A & B) and the Age Appropriate Visit Form (CFS652 F through T) for those done at non-CHE sites (hereafter referred to as CHE documentation). The Comprehensive Health Evaluation shall include an unclothed physical examination, vision screening, hearing screening, dental screening, referrals as needed, and appropriate data collection and reporting.
- At least 95% of all DCFS eligible Wards who reside within the Lead Agency's Territory shall receive a Comprehensive Health Evaluation and referrals as appropriate.
- At Least 95% of all DCFS eligible Wards residing in the Lead Agency's geographic area are enrolled in HealthWorks through selection of a HealthWorks primary care physician and are documented in the Lead Agency's file as having selected and are currently using a HealthWorks primary care physician. This information shall be updated at least annually.
- All physicians in the Lead Agency's geographic area who serve DCFS eligible Wards have been recruited for enrollment in the HealthWorks of Illinois program within ten (10) business days of receipt of identification of a non-enrolled health provider from the substitute caregiver, caseworker or medical case manager.
- Maintain on file at the Lead Agency's office the names, addresses and phone numbers of all physicians who have been recruited and ensure that each physician has completed the "HealthWorks of Illinois Physician Practice Profile."
- Interim Medical Case Management (IMCM) services, including selection of a HealthWorks primary care physician and documented completion of the Comprehensive Health Evaluation within 21 days of DCFS custody, are provided by the Lead Agency or its Medical Case Management Agency designee to 95% of all new DCFS eligible Wards. Documentation of the completed Comprehensive Health Evaluation, other accompanying health records, and prior medical records received must be sent to the caseworker within must be included in the information sent to the caseworker within 30 days of custody for inclusion in the Client Service Plan that is submitted to the court. Any additional material received before the end of the 45-days Interim Medical Case Management period shall be faxed to the caseworker within two (2) business days of its receipt. Any material received by the Lead Agency after the 45-day period shall be sent to the child's caseworker (and medical case manager if under age 6) within three (3) business days of receipt and a copy kept on file. All appropriate information, which would include at a minimum the date and provider of the Initial Health Screening, the date, provider, other scheduling information, results, and recommendations of the Comprehensive Health Evaluation, selection of the primary care physician, must be entered into SACWIS for all Interim Medical Case Management eligible wards.
- All new DCFS Wards under age six and pregnant Wards are assigned to Medical Case Management Agencies at the end of the IMCM period. Current DCFS Wards who become pregnant must also be assigned to a medical case management agency. The child's caseworker shall be notified of the medical case management agency assigned and the medical case manager's name and phone number.
- At least 95% of all enrolled DCFS eligible Wards under age six who reside within the Lead Agency's Territory shall be up-to-date on needed immunizations.
- At least 90% of all enrolled DCFS Eligible Wards under age six who reside within the Lead Agency's Territory shall receive all needed services as indicated in their individualized care plan.
- At least 95% of DCFS Eligible Wards under age six who reside within the Lead Agency's Territory are provided on-going age-appropriate Early and Periodic Screening, Diagnosis and Treatment Services (EPSDT), according to the schedule of periodicity or annually, whichever is more frequent.
- All primary care physicians shall complete the Department's Standardized DCFS Medical Record (including CHE documentation) and Referral forms; and send the Lead Agency a copy of the Medical Records and Referral forms within five (5) business days of the receipt of services for 100% of all DCFS Eligible Wards who reside within the Lead Agency's Territory.
- The Lead Agency shall follow up with the primary care physicians if they have not received copies of the medical records specified in #14 above within five (5) business days of the service.
- At least 95% of all DCFS Medical Record Forms and other health documentation received by the Lead Agency shall be sent to the child's caseworker (and medical case management agency if the child is under age 6), within three (3) business days of receipt of health documentation, including CHE documentation. The Lead Agency will provide copies of health documentation upon request by the child's caseworker.
- Copies of all HealthWorks forms completed by primary care physicians shall be collected, kept on file at the Lead Agency and forwarded to the child's caseworker. The Lead Agency will provide copies of health documentation upon request by the child's caseworker.
- Develop and maintain a documented network of specialty care providers that are available to DCFS eligible Wards in each Lead Agency area.
- Health case files of children reaching age six are transferred to the child's caseworker.
- The Lead Agency shall enter and update data in SACWIS for DCFS eligible Wards age six and older after the Interim Medical Case Management period. The information on the current primary care physician for the DCFS wards must be updated in SACWIS.
- The Lead Agency shall meet with medical case management agency(ies) or sub-provider(s) in the Lead Agency's jurisdiction at least quarterly to monitor, review and discuss the Medical Case Management Agency's or sub-provider's compliance with Lead Agency performance standards.
- The Lead Agency shall follow the DCFS statewide medical protocol for Drug Endangered Children (DEC) in illegal methamphetamine labs and the related outline for role and responsibilities of the HealthWorks Lead Agency and Medical Case Management Agencies. The DEC Protocol addresses the medical needs of children living in homes where methamphetamine and/or illegal drugs are being manufactured. This protocol is in conjunction with the Statewide Operational Agreement between DCFS and Illinois Law Enforcement Agencies for responding to families involved in drug manufacturing where children are expected to be present or found in the home.
- The Lead Agency shall work with DCFS and Department staff to maintain the health-related components of the Integrated Assessment Program (IAP) in accordance with the IAP requirements described as follows, including communication and coordination as necessary with other IAP participants:
* For children who are identified for the Integrated Assessment Program, the Lead Agency must coordinate its Interim Medical Case Management (IMCM) and care coordination efforts with Integrated Assessment Intake Coordinators within required timeframes. IMCM shall include the various components of the Integrated Assessment Program when a child has been identified as an Integrated Assessment case. Such responsibilities include but are not limited to:
- Searching for previous medical records/information from DHS and DHFS computer databases, previous medical providers, birth hospital, etc.;
- Coordinating with the Integrated Assessment Intake Coordinator, the child's caregiver and caseworker in scheduling the child's CHE;
- Assisting in finding the closest CHE site, even if it falls across county lines and into another Lead Agency's area. In such an event, the two Lead Agencies shall work together to coordinate service delivery;
- Contacting the caregiver to assist in the selection of a Primary Care Physician for the child;
- Contacting the caseworker to gather any additional child and family health history information received;
- Providing all available health information and necessary forms to the CHE site at least one day before the scheduled CHE; o Retrieving all health care documentation from the CHE immediately following the CHE;
- Entering into SACWIS the date of the CHE appointment, the date of the completed CHE, the CHE provider, results and recommendations from the CHE;
- All health care documentation will be sent to the caseworker and Intake Coordinator within 7 days after the completed CHE or within 28 days after temporary custody whichever comes first for inclusion in the DCFS Integrated Assessment Report and the DCFS Client Service Plan;
- After receiving the DCFS Integrated Assessment Summary Report from the Intake Coordinator, the Lead Agency will forward it to the child's selected PCP within 3 days.
- Notifying the appropriate IAP participant(s) of the assigned Medical Case Management Agency name, case manager and phone number.
* For other children new to DCFS temporary custody who are not served by the Integrated Assessment Program, the Lead Agency must perform the same functions related to provision, retrieval and distribution of the above-mentioned prior health history and health care documentation.
- DHS will be responsible for the following:
- Working with DCFS and the Lead Agency to maintain health-related components of the Integrated Assessment Program including coordination as necessary with other IAP participants.
- Directing the Lead Agency to develop and maintain a system of Comprehensive Health Evaluation sites that are enrolled with the Illinois Medicaid Program; meet Maternal and Child Health Primary Care Provider (MCHPCP) standards; and who will provide documented Comprehensive Health Evaluations as required by the Department of Children and Family Services.
- Ensuring that the Lead Agency and its Sub-contractors, if applicable (i.e. Medical Case Management Agencies), comply with the IAP requirements described above.
- Providing to DCFS an annual report, in a mutually acceptable electronic format, on the Lead Agency's Comprehensive Health Evaluation sites. Data provided shall include information to help monitor the use and effectiveness of the CHE sites (described above in Lead Agency Responsibilities).
- DCFS will be responsible for the following:
- Working with DHS and the Lead Agency to maintain health-related components of the Integrated Assessment Program outside of Cook County, including coordination as necessary with other IAP participants.
- Supplying a blank template to DHS for the electronic format for the annual Comprehensive Health Evaluation Site Network Report.
- The Lead Agency agrees to meet with the DCFS staff person(s) responsible for monitoring services under this Agreement as frequently as necessary to review and discuss the Lead Agency's and, if applicable, a Sub-Provider's performance under this Attachment. DHS staff will be included in these meetings as needed.
VI. Department Responsibilities
The Department agrees to fulfill the following responsibilities:
- Work with the Lead Agency, and, if applicable, a sub-contractor and primary care providers to establish necessary policy, procedure and operational directives for provider qualifications, treatment protocols, quality controls, referral practices, medical record transfers and communication systems.
- The Lead Agency and their Network Case Management agencies will receive from the Department, review and utilize the following quarterly reports to monitor performance:
- HWIL Client Summary-Source: Cornerstone
- HWIL Client Status-Source: Cornerstone
- HWIL DCFS Ward Provider Assignment-Source: Cornerstone
- HWIL Downstate Enrollment Summary Report, and
- Downstate Enrollment Report Form.
- Reporting Format Development
- The Summary Expenditure Documentation Form will be utilized to document expenditure of funds received through the prospective payments.
- Cornerstone and SACWIS as agreed upon by the Department and DCFS will be utilized to document performance by the Lead Agency Provider.
- Assist the Lead Agency in the provision of initial orientation and, as necessary, on-going training to primary care providers, medical case managers, DCFS and POS caseworkers, and substitute caregivers.
- Actively collaborate with DHFS and DCFS to ensure their full cooperation in securing the Lead Agency's interaction with the Family Case Management program and the timely resolution of any policy or operational problem which threatens the success of the health care system for DCFS Wards.
- Ensure, through active collaboration with DCFS, that DCFS and POS agency staff and substitute care givers cooperate fully as may be necessary to ensure children receive scheduled or necessary health care in a timely fashion.
- Ensure that any information relevant to a child's care which Department staff obtains is provided to a DCFS Ward's health care provider or the Lead Agency in a timely fashion.
- The Department will provide technical assistance and monitoring for all programs operated under Community Health and Prevention.
- DCFS is responsible for sending the Lead Agency weekly lists of Wards in their area new to DCFS custody, Wards who moved into their area from other Lead Agency areas, Wards whose DCFS case has closed or have become age (6), and pregnant and parenting Wards.
VII. Support Services -- Utilization of Community Resources
It shall be the responsibility of each project director to coordinate the services provided through the project with other sources of care in the community, such as:
- The Illinois Medical Assistance Program
- Local Health Departments
- Neighborhood Health Centers
- Local Child Development Clinics
- Division of Specialized Care for Children
- Local Hospitals
- Local Children and Family Services Programs
- Local Schools
- Vocational Rehabilitation Services
- Regional Perinatal Centers
- Local Early Intervention Programs for Infants and Toddlers with Handicaps
- Other related social service agencies
Please refer to 77 Ill. Adm. Code 630.160 and 630.170; Other Applicable Rules; and to the program-specific Exhibits for additional requirements.
VIII. Billing Instructions
Providers shall use the following methodology to document the use of these funds:
- The Provider shall provide summary documentation by line item of actual expenditures incurred for the purchase of goods and services necessary for conducting program activities. The Provider shall use generally accepted accounting practices to record expenditures and revenues as outlined in DHS Rule 509, Fiscal Administrative Recordkeeping and Requirements.
- Expenditures shall be recorded in the Provider's records in such a manner as to establish an audit trail for future verification of appropriate use of Agreement funds.
- Expenditure documentation shall be submitted in a format, defined by the Division of Community Health and Prevention, to the Department on a quarterly basis, within 30 days after the end of each calendar quarter. However, the Provider shall have the option to report monthly.
- The Provider shall submit expenditure documentation by one of the following means:
- Mailing Address:
Tom Evering, Accountant
815 East Monroe
Springfield, IL 62701
- Fax: 217-524-2491
- Email: firstname.lastname@example.org
- All financial record keeping on the part of the Provider shall be in accordance with generally accepted accounting principles consistently applied.
Expenditure Documentation Form Instructions
Expenditure Documentation Form
IX. Program Monitoring
Programs operated by the Provider under this contract will be monitored by the Department to review the program's progress according to stated goals, measurable objectives and administrative operations.
X. Program Budget
Providers agree to establish and utilize a budget approved by the Provider's Board of Directors.