Section 132

Section 132.30 Application, Certification and Recertification Processes

a) A State agency, subject to an executed interagency agreement with HFS in its capacity as the Medicaid State agency for Illinois, is authorized to perform the functions ascribed under this Part.

b) Any entity having a contract with a State agency for the provision of mental health services, other than hospital inpatient or hospital outpatient psychiatric services, with DCFS for the provision of child welfare services, with DCFS or DHS for the provision of youth services, or with DOC for the provision of youth treatment, rehabilitative or transitional services may apply for certification as a provider. Applicants who meet the requirements of this Part will be certified by one of the State agencies and enrolled as a provider in the Illinois medical assistance program by HFS pursuant to 89 Ill. Adm. Code 140.11. Providers will be certified by, and subject to, Medicaid certification review by only one State agency. Providers who are certified to provide comparable Medicaid services in other states may apply to a State agency for reciprocity consideration and enrollment. Providers applying for reciprocity consideration and enrollment will be subject to the same standards as those providers applying for certification under this Part.

c) Applications may be obtained by submitting a request in writing to:

Illinois Department of Human Services

Bureau of Accreditation, Licensure and Certification

401 North Fourth Street

Springfield, Illinois 62702

Illinois Department of Children and Family Services

Office of Medicaid Certification

406 East Monroe Street

Springfield, Illinois 62701

Illinois Department of Corrections

Office of Medicaid Certification

1301 Concordia Court

Springfield, Illinois 62794-9277

d) The applicant shall submit to DHS, DCFS or DOC a completed "Application for Certification of Medicaid Community Mental Health Services Programs" with all of the required accompanying components, as specified on the application form. An applicant shall submit its application to the Certifying State Agency that it intends to contract with for Part 132 services.

1) If an applicant intends to contract for Part 132 services with more than one State agency, the applicant shall submit its application to the State agency that provides the most funding for those Medicaid community mental health services.

2) If the funding from the Certifying State Agencies is equal, the applicant shall submit the application to DHS.

3) The application shall request information including, but not limited to:

A) Applicant name and corporate status;

B) List of services the applicant is requesting be certified;

C) Description of how each service to be certified fits into the programs of the applicant and other evidence of compliance with specific service definitions (see Section 132.150):

i) For Psychosocial Rehabilitation, the applicant must submit a work week schedule for each site, demonstrating 25 hours of available PSR and the name of the staff at each location who has co-occurring training or experience;

ii) For Assertive Community Treatment, the applicant must submit the names of staff on each team, indicating their credentials and their role on the team, e.g., person in recovery, experience in co-occurring disorders, and the time worked each week; and

iii) For Community Support Team, the applicant must submit the names of staff on each team, indicating their credentials and their role on the team, and the amount of time that each staff works on the team weekly;

D) List of sites to be certified and the services to be provided at each site;

E) Fire, electrical and plumbing clearances for each site, pursuant to Section 132.90;

F) The address of all accessible sites;

G) A staffing roster including staff qualifications and supervisory responsibilities for each of the sites;

H) Policies on confidentiality and third-party payments;

I) Utilization review plan; and

J) Medicare certification status.

e) If the application form and all of the required components are in compliance with this Part, the State agency shall issue to the provider a certificate for the Medicaid community mental health services program.

1) An applicant that submits an application that is not in compliance with this Part shall receive a Notice of Deficiencies. The Certifying State Agency shall issue the Notice of Deficiencies within 30 days after receiving the application. If the applicant intends to proceed with applying for Medicaid certification, the applicant shall submit corrected documentation to address all of the deficiencies. The applicant shall submit the corrected documentation to the Certifying State Agency that received the application and issued the Notice of Deficiencies.

2) The State agency shall issue the certificate within 30 days after the Certifying State Agency receives the completed application and all required components, including corrected documentation, if applicable. The effective date of certification shall be the date that the application or, if required, corrected documentation was approved. The Certifying State Agency shall also send the Medicaid enrollment forms to the provider. The provider shall complete the enrollment forms for each certified site to enroll those sites in the Illinois medical assistance program.

f) Certification shall be for a 3-year period.

1) A provider shall deliver only mental health services under this Part for which it is certified.

2) Any changes during the certification period that affect the ability of the provider to deliver services in compliance with the requirements of this Part shall be reported to the Certifying State Agency.

3) A provider is expected to provide Psychosocial Rehabilitation (PSR), Assertive Community Treatment (ACT), Community Support Residential (CSR) and Community Support Team (CST) services within 90 days after being notified of certification for the services. If the service is not implemented within 90 days, the provider must show compliance with the requirements in subsection (p) before the Part 132 services can be provided.

4) If a provider has been certified for PSR, ACT, CSR or CST and decides to no longer provide the services, the provider shall notify the Certifying State Agency at least 60 days prior to discontinuing the services. The service may be subject to removal from the certificate. Prior to discontinuing the service, the provider shall provide a plan for transitioning consumers to other services or to other providers.

5) The provider shall submit team rosters for ACT and CST upon public payer request.

g) Within 12 months after the date of initial certification, the Certifying State Agency shall conduct a review.

1) At the review, the Certifying State Agency shall evaluate the provider's compliance with this Part.

2) If no deficiencies are noted at the review, the Certifying State Agency shall notify the provider of the results within 30 days after the completion of the review. Compliance reviews for recertification shall be conducted on or about the expiration date of the current certification period.

3) If deficiencies are noted at the review, the Certifying State Agency shall report those deficiencies to the provider during an exit conference. The Certifying State Agency shall also issue a Notice of Deficiencies, return receipt requested, to the provider within 30 days after the completion of the review.

4) If the Certifying State Agency issues a Notice of Deficiencies to the provider, the provider shall respond with a Plan of Correction pursuant to Section 132.45(a). The Plan of Correction shall address all of the deficiencies listed on the Notice of Deficiencies. The Plan of Correction must identify the actions that have been, or will be, taken to comply with this Part and the timeframes for implementing the corrective actions. Unless otherwise specified, the timeframes for implementing corrective actions must follow the requirements specified in Section 132.45. The provider must submit this Plan of Correction to the Certifying State Agency within 30 days after the return receipt of the Notice of Deficiencies.

A) Providers that submit a Plan of Correction approved by the Certifying State Agency shall be notified of the approval. The Certifying State Agency shall notify the provider of the approval within 30 days after the Certifying State Agency receives the provider's Plan of Correction. The Certifying State Agency shall verify the provider's implementation of the Plan of Correction at the next review. If a Plan of Correction was required, the next review shall occur within 12 months after the date the Plan of Correction was approved.

i) If the findings at the next review indicate that a provider has failed to implement a Plan of Correction, the Certifying State Agency may revoke the provider's certification.

ii) Compliance reviews for recertification shall be conducted on or about the expiration date of the current certification period.

B) If a provider submits a Plan of Correction that does not address the deficiencies noted during a review pursuant to subsection (g)(4), the Certifying State Agency shall notify the provider within 30 days after receipt of the provider's Plan of Correction. The provider shall submit a revised Plan of Correction that addresses the deficiencies within 10 days after receiving notification. The Certifying State Agency may revoke the provider's certification if the provider fails to submit an acceptable revised Plan of Correction within 10 days after the return receipt date.

C) The Certifying State Agency may revoke a provider's certification if the provider fails to submit a Plan of Correction for deficiencies noted during a review within 30 days after receipt of the Notice of Deficiencies.

h) Compliance reviews for recertification shall be conducted on or about the expiration date of the current certification period. If the Certifying State Agency fails to conduct a compliance review for certification before the expiration of the current certification period, the certification shall remain valid until completion of the compliance review. Subsequent compliance reviews shall follow the process outlined in subsection (g).

i) The Certifying State Agency, HFS, or their respective agents, shall be granted access to all provider sites. All records shall be made available to the Certifying State Agency, HFS, or their respective agents, on request during the initial certification review, recertification reviews and any other compliance reviews for services delivered under this Part. Access to records shall occur in accordance with the Confidentiality Act.

j) An applicant/provider who has been decertified by Medicare shall not be eligible for certification under this Part.

k) When a decision is made to deny certification of an applicant or recertification of a provider, the applicant/provider may appeal the decision and request a hearing in accordance with Section 132.55 of this Part and Section 10-25 of the Illinois Administrative Procedure Act [5 ILCS 100/10-25].

l) If an applicant/provider has been denied certification or recertification, or if the provider's certification has been revoked, the applicant/provider may not reapply for certification under this Part for at least one year after the date of the final decision, including any appeals regarding certification, recertification or revocation.

m) Following a review, a provider shall be notified of its level of compliance with this Part as specified in Section 132.45.

n) The findings from a review shall be placed in one of the levels of compliance as described in Section 132.45.

o) Providers that seek certification for new sites shall submit the following documentation to the Certifying State Agency:

1) A clearance letter from the Office of the State Fire Marshal or approved local fire authority, dated within the preceding 12 months, stating that each additional site complies with local and State fire safety ordinances and codes pursuant to Section 132.90. For providers certified by DHS, the clearance letter must come from the Office of the State Fire Marshal only.

2) A signed statement from a licensed plumber or licensed architect, dated within the preceding 12 months, stating that each additional site complies with applicable plumbing codes pursuant to Section 132.90.

3) A signed statement from an electrician or licensed architect, dated within the preceding 12 months, stating that each additional site complies with applicable electrical codes pursuant to Section 132.90.

4) A signed statement from the provider, dated within the preceding 12 months, attesting to compliance with requirements of physical accessibility standards pursuant to Section 132.90.

5) A list of the Part 132 services that will be provided at the site.

p) Providers that seek certification for additional Part 132 services shall submit a description of the additional services, including evidence of compliance with specific service definitions in this Part, and the sites where the services will be delivered. Providers requesting to add Part 132 services whose standards are changed as a result of revisions to Sections 132.150 and 132.165 are expected to show compliance with standards as adopted. The description shall state how the additional services will be provided within the provider's program and shall include a listing of the LPHAs and QMHPs who will be responsible for directing the services. The provider shall submit the documentation for certification of additional services to the Certifying State Agency.

q) Additional sites or services must be approved by the Certifying State Agency before the additional sites or services may be considered for certification.

r) Approved additional sites or services shall be indicated on a revised certificate. If additional sites are certified, the provider shall enroll those sites in the Illinois medical assistance program. The addition of sites or services will not alter the expiration date of the certificate.

s) The Certifying State Agency shall survey any additional sites or services for compliance with this Part during the next review.

(Source: Amended at 32 Ill. Reg. 9981, effective July 1, 2008)