Section 240.1615  Provider Initiated Service Area Modifications

a)         To request approval to modify a service area, a certified provider agency must submit in writing to the Department a plan of the proposed expansion or reduction, reasons with supportive information for the modification, and the revised boundaries of the agency's original service area.

b)         The Department may approve or deny requests for service area modification based upon one or more of the following reasons:

1)         demonstrated ability or inability to comply with standards as illustrated by substantiated complaint history, review reports or prior contract actions;

2)         evidence of ability or inability to manage and supervise services throughout the current service area;

3)         continuity or disruption of participant care;

4)         assurance of, or failure to assure, participant freedom of choice; or

5)         action in, or failure to act in, the best interest of the participant or the CCP.

c)         If the Department approves the service area modification, the Provider Agreement shall be amended to include the modified service area.

d)         An agency shall provide a minimum of 60 days notice to the Department prior to the proposed effective date of a service area reduction.

e)         A provider who has been granted a provisional contract is not eligible for a service area expansion.

(Source:  Amended at 48 Ill. Reg. 11053, effective July 16, 2024)