TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES
SECTION 120.70 SERVICE PROVIDER REQUIREMENTS


 

Section 120.70  Service provider requirements

 

a)         Services shall be provided by governmental agencies, not-for-profit agencies, or privately owned agencies which are operated for profit.  All providers shall operate under contractual obligation with the Department and shall be enrolled as Medicaid providers with the Department of Public Aid. Providers shall include current service providers as well as new agencies. Providers shall meet Department standards applicable to the specific services to be provided and shall demonstrate competency to provide services.

 

b)         Contract obligations

            Service providers participating under this Part shall execute a purchase of service contract or grant agreement with the Department in accordance with Section 15 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15] and Section 4 of the Community Services Act [405 ILCS 30/4].

 

c)         Provider agreement and enrollment

 

1)         Service providers participating under this Part shall execute a three-party Medicaid provider agreement with the Department of Public Aid and the Department and be enrolled as Medicaid providers in the Department of Public Aid Medicaid Management Information System (MMIS).

 

2)         The provider agreement shall note that the provider voluntarily requests assignment of payment for program services to the Department which shall arrange for payment to the provider.

 

3)         The service provider purchase of service contract or grant agreement and the Medicaid provider agreement shall be the obligating instruments which provide the basis for financial participation for the Medicaid home and community-based services waiver program.

 

d)         Provider requirements

            Service providers shall contractually agree to meet the fiscal, program and reporting requirements of the Medicaid home and community-based services waiver program and shall be willing to serve former or potential residents of State-operated developmental centers or community ICF/MRs.  Service providers shall also be in compliance with applicable Medicaid provider requirements, appropriate licensure procedures and/or standards as well as Department operational procedures for purchase of service or grant programs (see the Department's Rules at 59 Ill. Adm. Code 103, 113, 115 and 119).  They shall also comply with intake, assessment, monitoring and billing procedures established for services under this Part.

 

e)         Provider payments

            Service providers delivering  authorized services to individuals determined eligible under the Medicaid home and community-based services waiver program shall be paid by the Department on a monthly basis on submission of service reports/billing statements.

 

f)         Monitoring of providers

            Service providers shall cooperate with quality assurance monitoring, evaluations and information requests conducted by the Department of Public Aid, the Department, or by other entities that are authorized by the Department of Public Aid or the Department, such as individual service coordinators, PASARR agents, auditors or evaluators.

 

g)         Appeals by providers

 

1)         As the single State Medicaid agency, the Department of Public Aid is responsible for conducting all provider hearings and rendering the final administrative decision.  The appeal requirements and process are contained in the Department of Public Aid's rules at 89 Ill. Adm. Code 104.200 through 104.210.

 

2)         The Department shall conduct informal reviews of provider appeals to attempt to resolve issues without a formal hearing.

 

(Source:  Amended at 20 Ill. Reg. 4762, effective March 8, 1996)