Section 132.55  Appeal of Certification Decisions

a)          An applicant or provider may appeal the following to the Certifying State Agency:        

1)         Refusal to issue certification;

2)         Refusal to issue recertification; or

3)         Revocation of certification.

b)         Certification appeal criteria and process

1)         If the Certifying State Agency determines that certification or recertification should not be issued or that certification should be revoked, the Certifying State Agency  shall send, by certified mail, return receipt requested, written notice to the applicant or the provider within 30 days after the determination.  The notice shall contain the specific requirements with which the applicant or provider has not complied, the Certifying State Agency's proposed action, and the applicant or provider rights as follows:

A)        If the applicant or  provider chooses to appeal the Certifying State Agency's decision, the applicant or provider shall submit a written request for a hearing to the Certifying State Agency within 20 days after the dated receipt of the notice. 

B)        If an appeal is initiated by a provider, services shall be continued pending a final administrative decision unless the Certifying State Agency also determines, and notifies the provider, that conditions specified in Section 132.45(c) apply.

C)        The request for a hearing shall be addressed to the appropriate Certifying State Agency as follows:

                                                Illinois Department of Human Services

                                                Bureau of Administrative Hearings

                                                100 South Grand Avenue East, 3^rd Floor

                                                Springfield IL  62762-0001

                                                            or

                                                Illinois Department of Children and Family Services

                                                Office of Medicaid Certification

                                                406 East Monroe

                                                Springfield IL 62701-1498

                                                            or

                                                Illinois Department of Corrections

                                                Office of Medicaid Certification

                                                1301 Concordia Court

                                                Springfield IL  62794-9277

2)         If the applicant or provider does not submit a request for a hearing, as provided in this Part, or if, after conducting the hearing, the Certifying State Agency determines that the certification or recertification should not be issued or that the certification should be revoked, the Certifying State Agency shall issue an order to that effect.  If the order is to revoke the certification, it shall specify that the order takes effect upon receipt by the provider and that the provider shall not provide Medicaid community mental health services during the pendency of any proceeding for judicial review of the Certifying State Agency's decision, except by court order.

(Source:  Amended at 31 Ill. Reg. 9097, effective July 1, 2007)