4.2 Eligibility

Revised October 2019

HRIF may be provided when the client 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.

HRIF infants or children will be followed until 24 months of age unless a complete assessment and the professional judgment of the nurse case manager at the first visit or any subsequent visits indicate that services are no longer needed. These clients and those whose conditions are minor and whose environments are stable may be transferred into Family Case Management.

HRIF services take precedence over HealthWorks of Illinois Medical Case Management.

4.2.1 APORS DESIGNATION PROCESS

APORS staff at Illinois Department of Public Health (IDPH) collect case information from hospitals and other sources, such as the Newborn Metabolic Screening Program and the Newborn Hearing and Screening Program. IDPH APORS staff will proceed as follows once data has been collected:

  1. Review the information provided by the hospitals and other sources, checking for inconsistencies and missing information. IDPH APORS refers any identified problems to the reporting hospital for resolution.
  2. Review and code the list of diagnoses provided by hospitals and other sources. If the codes do not meet the APORS case criteria/definition (Examples: the baby did not die, was not less than 31 weeks gestation, the mother was not Hepatitis B positive or infant has a genetic disorder, etc.) per the IDPH APORS Case Definition Chart (Addendum 4.2.1 APORS Case Definition), then the case does not meet eligibility criteria for APORS.
  3. Enter the case into the APORS database if the report was received by paper.
  4. The IDPH APORS Review field in the software system is completed with a "Y" if there are no problems with the case, and the baby has not gone to an equal or higher-level reporting facility.
  5. Once these steps are completed, the record is made available electronically to the local health department or community agency staff thru the IDPH APORS referral portal.

If further assistance is needed with APORS Referrals, please contact the APORS IDPH Manager: Jane Fornoff at 217-785-7133 or Jane.Fornoff@illinois.gov.

4.2.2 PROCEDURE TO CHANGE HRIF DESIGNATION TO APORS

For an infant without a receipt of an APORS referral, contact the APORS Program by email at dph.apors@illinois.gov to request the APORS report. Before requesting such a report, the nurse should review the IDPH APORS Case Definition Chart (Addendum 4.2.2 Case Definition Chart) to verify that the child meets the APORS case definition. Do not add "Y" (yes) APORS on Cornerstone PA11 (Birth Data) screen until an APORS report is received. If an infant has a high-risk condition that is not reportable to APORS, the infant may be provided HRIF services. Do NOT add "Y" (yes) to the APORS question on Cornerstone PA11 Birth Screen; it remains "N" (No).