Section 240.1665  Contract Actions for Failure to Comply with Community Care Program Requirements

The Department may impose one or more of the following contract actions upon any CCP provider or contracted CCU that fails to comply with Department rules or contract/Provider Agreement requirements, including any statements made on the CCU Proposal or the provider's application for certification.  These actions include:

a)         prohibition of specified staff from serving CCP participants (imposed when the Department finds that a worker, case manager, supervisor or other designated staff fails to comply);

b)         purchase of a limited financial audit (imposed when the Department finds that a provider or CCU has failed to adhere to the fiscal requirements specified in this Part);

c)         suspension of referrals for up to 90 days;

d)         transfer of a portion of the participants served under the contract or Provider Agreement;

e)         training of staff;

f)         termination of Provider Agreement or CCU contract and transfer of all participants;

g)         requiring a review by the provider or CCU of all or a specified subset of files and provider or CCU certification of corrective action;

h)         requiring the provider or CCU to contract with an outside management firm to evaluate program management and to implement recommendations for improvement as provided in the evaluation and negotiated with the Department;

i)          suspending all or a portion of CCP payments until the action is corrected;

j)          deducting overpayments to provider or CCU from future Provider or CCU Requests for Payment or requiring the provider or CCU to reimburse the Department;

k)         refusing to accept a proposal from a CCU or to enter into a Provider Agreement with the provider in one or more specified areas open for procurement; and/or

l)          taking any other action the Director determines to be appropriate to the non-performance circumstances.

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