Section 140.488 Periodicity Schedules, Immunizations and Diagnostic Laboratory Procedures

Section 140

Section 140.488  Periodicity

Schedules, Immunizations and Diagnostic Laboratory Procedures

a)         Health Screening Periodicity Schedule.  Eligible clients may

receive one periodic health screening during each of the following time

periods, except a second screening may be given as explained in Section

140.485(d)(2):

1)         birth to two weeks;

2)         two weeks to one month;

3)         one to two months;

4)         two to four months;

5)         four to six months;

6)         six to nine months;

7)         nine to 12 months;

8)         12 to 15 months;

9)         15 to 18 months;

10)         18 to 24 months;

11)         two to three years;

12)         three to four years;

13)         four to five years;

14)         five to six years;

15)         six to eight years;

16)         eight to 10 years;

17)         10 to 12 years;

18)         12 to 14 years;

19)         14 to 16 years;

20)         16 to 18 years; and

21)         18 to 21 years.

b)         Vision

Screening Periodicity Schedule

1)         Vision screening using age appropriate methods shall be part

of all periodic or interperiodic health screenings.

2)         Beginning at age three through 20 years, the Department will

pay for one vision screening performed by a qualified provider per year for an

eligible child.  However, the Department will pay for other such screenings

when medically necessary, regardless of a child's age or medical history.

c)         Hearing

Screening Periodicity Schedule

1)         Hearing screening using age appropriate methods shall be part

of all periodic or interperiodic health screenings.

2)         Beginning at age one year for children at high risk for

hearing problems and age three years for all other children, the Department

will pay for one hearing screening performed by a qualified provider per year

for an eligible child.  However, the Department will pay for other such

screenings when medically necessary, regardless of a child's age or medical

history

health screenings.

2)         Beginning at age one year for children at high risk for

hearing problems and age three years for all other children, the Department

will pay for one hearing screening performed by a qualified provider per year

for an eligible child.  However, the Department will pay for other such

screenings when medically necessary, regardless of a child's age or medical

history.

d)         Dental

Screenings Periodicity Schedule

1)         Effective for dates of service on or after July 1, 2014, the

dental periodicity schedule is available at the Department's website at http://www2.illinois.gov/hfs/MedicalProvider/MedicaidReimbursement/

Pages/Dental.aspx.

Examination of a child's oral cavity, including the status of the teeth and

gums, shall be part of each periodic or interperiodic health screening.

2)         Effective for dates of service on or after July 1, 2014,

beginning at age one through 20 years, the Department will pay for one clinical

oral examination and one oral prophylaxis not more frequently than once every

six months performed by an enrolled dentist.  However, the Department will pay

for additional services when medically necessary, regardless of a child's age

or medical history.

e)         Immunizations.

1)         Immunizations for children that are recommended by the

Advisory Committee on Immunization Practices (ACIP) are covered without cost

sharing under 89 Ill. Adm. Code 140.402(d)(2).  Current ACIP child vaccine

recommendations can be found at https://www.cdc.gov/ vaccines/hcp/imz-schedules/child-adolescent-age.html.

2)

In compliance with section

1905(a)(13)(B) of the Social Security Act (42 U.S.C. 1396(d), and pursuant to

89 Ill. Adm. Code 140.402(e)(11), adult vaccines recommended by ACIP are also

covered without cost sharing.  Current ACIP adult vaccine recommendations are

listed at https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html.

f)         Diagnostic Laboratory Procedures

scent-age.html.

2)

In compliance with section

1905(a)(13)(B) of the Social Security Act (42 U.S.C. 1396(d), and pursuant to

89 Ill. Adm. Code 140.402(e)(11), adult vaccines recommended by ACIP are also

covered without cost sharing.  Current ACIP adult vaccine recommendations are

listed at https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html.

f)         Diagnostic Laboratory Procedures.  The Department will pay for

covered diagnostic laboratory procedures as medically necessary including but

not limited to:

1)         Urinalysis, routine (ph specific gravity protein tests for

reducing substances such as glucose), with microscopy;

2)         Urinalysis routine without microscopy;

3)         Chemical, qualitative, any number of constituents;

4)         Cholesterol, serum; total;

5)         Cholesterol, serum; total and ester;

6)         Lead Screening, Blood Lead;

7)         Gonadotropin, chorionic quantitative pregnancy test;

8)         Gonadotropin, chorionic qualitative pregnancy test;

9)         Hematocrit;

10)         Hemoglobin Colorimetric;

11)         Sickle RBC, reduction slide method;

12)         Hemoglobin Electrophoresis;

13)         Sickle Hemoglobin;

14)         Tuberculosis intradermal;

15)         TB Tine Test;

16)         Syphilis Test, qualitative;

17)         GC Culture Test, bacterial screening only;

18)         Culture presumptive, pathogenic organisms screening only;

19)         Culture, multiple organisms;

20)         Urine culture colony count;

21)         Urine bacteria count, commercial kit;

22)         Urine bacteria culture, identification, in addition to colony

count and commercial kit;

23)         Chlamydia Culture;

24)         Pap Smear, Cytopathology;

25)         Epidemological study of a child's living environment when a

child has been diagnosed as having an abnormally high blood lead level;

26)         Denver Developmental Screening Test; and

27)         Other developmental tests that may be approved by the

Department.