Section 240.1570   Service Availability Expansion

a)         A CCP participant may be allowed access to CCP adult day services in a service area in which the participant does not reside (outlying service area) under the following circumstances:

1)         the CCU has determined the needs of the participant may best be served by a provider in an outlying service area;

2)         either:

A)        the geographic area in which the participant resides does not have a provider of the needed services; or

B)        the participant may be provided services more conveniently/appropriately by a CCP provider in an outlying service area for the following reasons:

i)          the authorized CCP providers in the participant's service area have reached the maximum capacity and have approval to not accept new participants and/or is unable to provide a service without delay and/or interruption;

ii)         optional service components required by the participant are unavailable from the CCP authorized provider in the participant's service area but are available from a CCP authorized provider in another service area; 

iii)        transportation can be more conveniently arranged to a CCP authorized provider in another service area (adult day service only); or

iv)        special needs of the participant (e.g., language-appropriate workers) can only be met by a CCP authorized provider in another service area; and

3)         The CCP authorized provider in the outlying service area agrees to provide the service required without delay/interruptions to the referred participant.

b)         A CCP in-home care participant may be allowed access to CCP in-home care services in a service area in which the participant does not reside (outlying service area) upon receipt of written approval to the CCU from the Department under the following circumstances:

1)         The CCU has determined that the special needs of the participant (e.g., language specific workers) can only be met by a CCP authorized provider in another service area; and

2)         The CCP authorized provider in the outlying area agrees to provide the service required without delays/interruptions to the referred participant; and

3)         The CCP authorized providers in the participant's area of residence are unable to meet the special needs of the participant without delays/interruptions.

c)         A request by a participant to receive CCP services from a provider in an outlying service area is inappropriate if the participant refuses to accept CCP services deemed appropriate by the CCU in the participant's service area.  In this instance, service will be denied or terminated as appropriate.

d)         If a provider's contract period is extended in writing by the Department, approval of the service availability expansion is also extended for the same effective period.

(Source:  Amended at 42 Ill. Reg. 20653, effective January 1, 2019)