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Elizabeth M. Whitehorn, Director

Provider Notice issued 06/27/06

All Kids Health Insurance Program – Cost Sharing

To:​ Qualified Health Center (FQHC), Encounter Rate Clinic (ERC) or Rural Health Clinic (RHC) and Hospitals billing fee-for-service​
Date:​ June 27, 2006​
Re:​

All Kids Health Insurance Program – Cost Sharing

Effective with dates of service on or after July 1, 2006, HFS’s medical coverage for children will expand under the provisions of Governor Blagojevich’s new All Kids program. As part of this expansion, Medicaid and KidCare coverage of children has been renamed All Kids as well.

 

All Kids Cost Sharing Requirements

 

The attached chart shows the co-payment amounts for the All Kids program. Appendix 12 and 13 of the Chapter 100, General Policy and Procedures Handbook will be updated in the near future to reflect the new co-payment requirements. Chapter 100 is available on the department’s Web site at: <http://www.hfs.illinois.gov/handbooks/>

The expanded coverage has been named All Kids Premium Levels 2 through 8 to correspond with seven income groups. Cost sharing, for children covered under the expansion to higher income levels, includes co-payment amounts that vary by family income. Please note that co-payment requirements for children previously covered under All Kids (KidCare) have not changed.

 

Under All Kids Premium Levels 2 through 8, a co-payment will be assessed on certain fee-for-service visits to a physician, chiropractor, podiatrist, optometrists, nurse practitioner or hospital and on all billable encounters (medical and behavioral health) at a FQHC, ERC or RHC.

 

Effective with dates of service on or after July 1, 2006, co-payments will be applied to the following CPT code ranges for services provided to a child, 18 years of age or younger, except when these codes are billed with modifiers “EP” (EPSDT) or “FP” (Family Planning):

 

CPT Code Range General Description
99201 – 99215 Office Visit
99241 – 99245 Consultations
90801 – 90911 Psychiatric Evaluation
92002 – 92015 General Ophthalmologic Services
98940 – 98943 Chiropractic Manipulative Treatment
T1015 Encounter Rate

 

Collection of Co-payments

 

The department will automatically deduct the co-payment for All Kids Premium Levels 2 through 8 from the provider’s reimbursement. When billing the department, providers should bill their usual and customary charge and should not report the co-payment on the claim. Providers will be responsible for collecting co-payments from the participant. Providers may choose not to charge a co-payment, but if co-payments are charged, the co-payment amount cannot exceed the amounts shown on the attached table.

 

Federal regulations stipulate that a provider cannot deny services to an individual covered under a Title XIX or Title XXI program due to the person’s inability to pay a co-payment. This requirement does not apply to the All Kids Premium Levels 2 through 8. Providers may apply their office policies relating to the co-payments to participants covered under the All Kids Premium Levels 2 – 8.

 

Eligibility Verification

 

Providers will be able to determine the appropriate co-pay amount for a child using the MEDI or REV eligibility verification systems. The AVRS eligibility system will only identify the All Kids coverage level, not the specific co-pay amount.

 

In addition, the All Kids medical cards issued to families with children covered by All Kids Premium Levels 2 – 8 will contain the following message:

 

Co-pays apply for most medical services. There are no co-pays for immunizations for children and well-child visits. To obtain co-pay status, providers may use the MEDI Web site at: www.myhfs.illinois.gov, a REV vendor, or call 1-800-842-1461, the Automated Voice Response System.

 

To register to use the MEDI system for verifying eligibility, go to: <http://www.myhfs.illinois.gov/>. Information on the REV System can be found in Topic 131.2 of the Chapter 100, General Policy and Procedures Handbook available on the department's Web site at: <http://www.hfs.illinois.gov/handbooks/>. The AVRS Provider Health Care Hotline can be reached by dialing1-800-842-1461

 

For additional information regarding the All Kids Program, visit the following Web site http://www.allkidscovered.com/

 

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs

 

Copayments for Children Enrolled in All Kids (pdf)