Section 240.1600  Provider Agency Certification

a)         All services provided to CCP participants shall be delivered in accordance with Provider Agreements entered into between certified provider agencies and the Department.

b)         For purposes of administrative efficiency, the Department may initiate the provider certification process for the CCP by a specific service, on a geographic basis, or in accordance with other criteria determined by the Department.

c)         Initial Certification

Any willing and qualified provider agency (see the federal Medicaid waiver, this Part and 42 CFR 431.51 (2008)) interested in the opportunity to enter into a Provider Agreement with the Department for the provision of CCP services shall comply with the following certification procedures:

1)         A provider agency requesting initial certification of qualifications shall submit, in a form and manner prescribed by the Department, material documenting the ability to comply with administrative requirements, service specifications and any other administrative or operational information required by the Department for the applicable service.

A)        The Department or its designee will review the material submitted and, if necessary, will request additional information.  The Department or its designee will conduct on-site reviews of a prospective provider agency for in-home service and adult day service under the CCP unless a performance review of the provider agency has already been completed by the Department or its designee within the prior 12 months.  The Department reserves the right to conduct on-site reviews of a prospective provider agency for emergency home response service and AMD service under the CCP.

B)        If additional information is requested by the Department, the provider agency has 30 calendar days after the date of request to submit this information.

C)        After 60 calendar days, the provider agency's request for certification of qualifications will be closed and all information must be resubmitted to the Department if the provider agency wants to continue to request certification.

2)         Provider agencies will be notified in writing of the results of the certification request.  Those provider agencies determined by the Department to be qualified will be certified for a period of no more than 3 years and afforded the opportunity to execute a Provider Agreement (generally for a 3-year period) for the applicable service.

d)         Recertification

The Department, or its designee, shall conduct recertification of each provider agency with a valid Provider Agreement no less frequently than every 3 years to determine continued compliance with qualifications for the applicable service.  The timing of recertification shall be based upon the timing of the initial certification (see subsection (b)) or of the most recent recertification.

1)         The Department, or its designee, shall notify each provider agency, in writing, at least 30 calendar days prior to recertification to request the material required for the recertification.  Any provider agency interested in renewing its Provider Agreement shall submit, in a form and manner prescribed by the Department, material documenting the continued ability to comply with the administrative requirements, service specifications, and any other administrative or operational information required by the Department for the applicable service.

2)         Before recertifying a service provider, the Department will conduct a performance review under Section 240.1660.

3)         Provider agencies will be notified in writing of the results of the recertification.

4)         Those provider agencies determined by the Department to be qualified will be recertified for a period of no more than 3 years and afforded the opportunity to execute renewal of the Provider Agreement (generally for a 3-year period) for the applicable service.

e)         Other initial certification or recertification considerations include, but are not limited to:

1)         pending or current Departmental on-notice or contract action for failure to adhere to Provider Agreement requirements, including a history of non-compliance with the Provider Agreement;

2)         notification from another governmental entity of similar contract actions or non-compliance findings;

3)         financial insolvency, criminal indictment or conviction, or other legal issues that, in the opinion of the Department, would make the award of a Provider Agreement contrary to the best interest of the State;

4)         complaints forwarded to the Department by the Attorney General's office, the Better Business Bureau or other consumer protection organizations; or

5)         the current provider agency is not in good standing with the Department.

f)         The Department may require completion of additional disclosure statements and/or background inquiries if there is reason to believe offenses have occurred since completion of previous disclosures and background inquiries.

g)         The Director shall represent and act for the State in all matters pertaining to the Application for Certification process and Provider Agreements awarded.  The Director receives all recommendations and has the ultimate decision making authority for issuing Provider Agreements.  The Director reserves the right to allow the applicant to correct inadvertent, technical errors in the application when, in the Director's opinion, the best interest of the State will be served by the correction.

h)         Any provider agency denied initial certification of qualifications or recertification for the provision of CCP services shall be afforded the opportunity to submit another request to the Department after a 60-day period of time after issuance of the determination or notification of a final decision or other action on an objection filed pursuant to Section 240.1645.  The provider agency may also object to the decision in a form and manner prescribed by the Department in the written notification of denial (see Section 240.1645).

i)          Provider Agreements will be entered with qualified provider agencies on a schedule determined by the Department, but no more frequently than semiannually after initial certification.

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