Section 2090.30 Medicaid
Certification/Enrollment/Recertification
a) Providers may be certified and recertified by the Department
as set forth herein and may enroll for participation in the Illinois Medical
Assistance Program as provided in 89 Ill. Adm. Code 148.340(d). Application
for Medicaid certification and enrollment for alcoholism and other drug abuse
treatment service providers may be made by providers who are:
1) Currently licensed by the Department under the provisions of
77 Ill. Adm. Code 2060 for alcoholism and other drug abuse treatment services
described in 77 Ill. Adm. Code 2060.
2) Currently licensed by the Illinois Department of Public Health
as a hospital pursuant to 77 Ill. Adm. Code 250 for the treatment services
described in 77 Ill. Adm. Code 250.
b) Medicaid Certification
1) Applications for certification may be obtained in person or by
writing to:
Illinois Department of Human Services
100 W. Randolph, Suite 5-600
Chicago, Illinois 60601
Attention: Division of Licensing and Certification
2) Applicants for new certification will be accepted from
programs or parent organizations of such programs which have been licensed as
specified in this Section for at least two years. Applicants shall demonstrate
two years of experience in providing quality substance abuse services of the
kind for which certification is being requested and for the type of population
which will be served.
3) Applicants shall submit documentation of the following:
A) evidence of the need within the community for the type of
services to be provided by the program for which certification is sought;
B) description of the organization that will be operating the
program;
C) fiscal solvency of the organization;
D) description of the physical facilities to be utilized by the
program;
E) description of the program and the clientele it serves;
F) projection of the total number of Medicaid clients to be
served each month, the average length of stay anticipated, and the estimated
average per person cost of treatment;
G) schedule of the specific dates, times and places services will
be provided;
H) number and type of people served during the previous two years
in the program for which certification is sought and a description of the
people served (demographics, gender, drug of choice, Medicaid eligibility,
income level, etc.);
I) name, address and professional qualifications of the program's
Medical Director;
J) name and qualifications of each individual who will be
staffing the program and a description of that individual's responsibilities
with respect to the program;
K) copies of written referral agreements with other social service
systems and primary medical care service systems within the applicant's area;
L) copies of linkage agreements with other substance abuse
treatment programs within the applicant's area implemented to assure
availability of all levels of care as required in 77 Ill. Adm. Code 2060;
M) documentation of the program's quality assurance system and
utilization review policy as applied to the program's clinical standards which
have been used for the previous two years, with a copy of the two most recent
utilization review reports; and
N) measurable outcome evaluation process used for the past two
years and statistics on the program's client outcomes.
4) Applicants shall submit evidence that they are in compliance
with all applicable Department audit requirements as specified in 89 Ill. Adm.
Code 507.
5) Applications which are missing significant components or which
have inadequate information shall be returned to the applicant with a statement
specifying the missing or inadequate information. Completed applications may be
resubmitted. Applications which are missing less significant components may be
held by the Department and the applicant notified in writing of the missing
information. The applicant may submit only the missing components. The
Department shall hold such incomplete applications no more than 30 calendar
days.
6) Certification is site-specific and services are to be provided
on-site, unless they are provided in accordance with the off-site service
provisions as set forth in 77 Ill. Adm. Code 2060.203.
7) Sites providing 24 hours of services to clients and having
more than 16 beds shall not be certified for Medicaid enrollment for other than
adolescent residential rehabilitation services.
8) In order to receive certification for a site having 16 beds or
less, a program must meet the following criteria:
A) be a free-standing program of 16 or fewer beds; or
B) be within a larger facility, as a distinct unit of 16 beds or
less, which:
i) is licensed;
ii) is physically separate from other certified and licensed programs
(for example, separated by floors, wings, or other building sections);
iii) provides a level of care significantly different in clinical
content from other certified and licensed programs (for example, adult versus
adolescent care, women versus men, hearing impaired versus non-impaired);
iv) has a separate cost center (budgeting, accounting, etc.);
v) has separate staffing; and
vi) has separate operating policies and procedures.
9) Prior to certification, the Department shall conduct an
on-site inspection.
10) Based upon the on-site inspection and a review of the
application for certification, the Department will certify the program if the
Department determines that:
A) the applicant has proven that an unmet need for the services
exists in the community the program will serve;
B) the organization operating the program is fiscally sound and
responsible;
C) the program management is experienced in business and in the
delivery of substance abuse services;
D) the program has sufficient written agreements with social,
medical and other substance abuse service providers within its area to assure
proper linkage of services to an individual;
E) the program has experience with the Medicaid eligible
population it intends to serve;
F) the program has adequate physical facilities and adequate
numbers of professional staff to provide the services;
G) the program conducts utilization review and has a quality
improvement plan; and
H) the program has a measurable outcome evaluation process in
place that provides measurable indicators of improvement by program
participants.
11) The Department shall notify the applicant in writing of its
determination regarding certification.
A) Approval of Certification/Medicaid Enrollment
If the Department certifies the program, it shall include the
IDPA Medicaid enrollment forms with the letter of certification. The applicant
shall submit the completed enrollment forms along with a copy of the letter of
certification to IDPA. However, providers who have applied for hospital
licensure for the first time and hold a provisional hospital license for
treatment services are not eligible to apply for Medicaid enrollment for those
treatment services.
B) Denial of Certification
If the Department is not able to certify the program based on
the criteria outlined in this Section, the Department shall notify the
applicant in writing, describing those deficiencies that will result in a
denial of the certification. The applicant has 60 days after receipt of the
notice to correct the deficiencies and supply the new information to the
Department. If the new information indicates that the program meets the
criteria of this Part, the Department shall certify the applicant. If the
program continues to fail to meet the requirements of this Part, the Department
shall deny the application for certification. If certification is denied, the
applicant may appeal the Department's decision and request a hearing pursuant
to 89 Ill. Adm. Code 104: Subpart C (Medical Vendor Hearings).
12) Certification shall be effective on the date of approval by
the Department and shall remain in effect until the expiration of the
provider's license as required in this Section or for three years for any
provider not licensed by the Department. Certification is also subject to any
sanctions levied under Section 2090.100 of this Part. After the effective date
of certification, the provider may deliver services to Medicaid recipients that
will be reimbursable after the applicant completes the IDPA Medicaid enrollment
procedure.
13) When and if a certified provider is no longer licensed as set
forth in this Section (whether voluntarily or involuntarily) the certification
shall be null and void. Upon proof by the Department's licensing division that
the license is no longer in effect, the Department shall notify the provider by
certified mail that certification is null and void.
14) Recertification
A) To be eligible for recertification, providers shall be in
compliance with all Sections of 77 Ill. Adm. Code 2060 referenced in this Part.
B) To be eligible for recertification, providers who receive
funding from the Department shall be in compliance with all applicable
Department audit requirements specified in 89 Ill. Adm. Code 507.
C) Providers shall apply for recertification at least 90 days
prior to the expiration of the provider license.
D) Providers shall submit a recertification application provided
by the Department. In addition, the provider shall submit copies of all
utilization review (UR) reports and results of the program's measured outcome
evaluations since the date of last inspection.
E) The Department shall review all documents and the results of
the last licensure inspection and shall recertify the program if it complies
with the requirements of the Alcoholism and Other Drug Abuse and Dependency Act
and this Part.
15) Denial of Recertification
If the Department is not able to recertify the program based
on its review and inspection, the Department shall notify the applicant in
writing, describing those deficiencies that will result in a denial of the
recertification. The applicant has 30 days after receipt of the notice to
correct the deficiencies and supply the new information to the Department. If
the new information indicates that the program meets the criteria of this Part,
the Department shall recertify the program. If the program continues to fail
to meet the requirements of this Part, the Department shall deny the
application for recertification and shall notify the applicant in writing,
giving the reasons for the denial. The provider may appeal the Department's decision
and request a hearing pursuant to 89 Ill. Adm. Code 104: Subpart C (Medical
Vendor Hearings). Certification shall remain in effect pending the final
decision on recertification unless the provider is sanctioned pursuant to
Section 2090.100 of this Part. When the denial of recertification is final,
the provider shall arrange for transfer of all Medicaid clients of the program
as appropriate.
(Source: Amended at 23 Ill. Reg. 13879, effective November 4, 1999)
 |
TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.35 GENERAL REQUIREMENTS
Section 2090.35 General
Requirements
a) To be reimbursable, treatment services shall be provided in
compliance with all provisions specified in 77 Ill. Adm. Code 2060.
Specifically, physician and professional staff involvement in treatment
services shall be in compliance with 77 Ill. Adm. Code 2060.417, 2060.419,
2060.421, 2060.423 and 2060.425. The provider shall only bill for services
that are reimbursable.
b) The provider shall submit Medicaid claims as soon after the
service date as is reasonable unless there is good cause for later submission.
In any event, all claims for services (both initial and previously rejected)
must be submitted to the State on a timely enough basis to be paid within 12
months from the date of service. If such claims are not submitted within this
time frame, the provider may request an exception from the Department and IDPA
to allow these claims to be processed. Exceptions will only be granted if it is
determined that the delay in submission was due to Department or IDPA
processing errors.
c) Information
Collection
1) The provider shall report, on a monthly basis, demographic and
service system data using the Department's Automated Reporting and Tracking
System (DARTS), in the manner and data format prescribed by the Department.
The data collected shall be for the purpose of assessing individual client
performance and for planning for future service development. Information to be
reported by the provider, for each individual served by a program certified
under Section 2090.90 of this Part, shall include but is not limited to the
following:
A) Name, date of birth, gender, race and national origin, family
size, income level, marital status, residential address, employment, education
and referral source.
B) Special population designation, such as Medicaid eligible
clients, women with dependent children, intravenous drug users (IVDUs), DCFS
clients, DHS clients, and criminal justice clients.
C) Drug/alcohol problem areas treated, characterized by drugs of
use, frequency of use, and medical diagnosis.
D) Closing date information, such as the reason for discharging
the client from the program.
2) The Department shall supply providers with DARTS software.
3) Disclosure of information contained within DARTS is governed
by the specific provisions of federal regulations under Confidentiality of
Alcohol and Drug Abuse Patient Records (42 CFR 2 (1997)) and the Health
Insurance Portability and Accountability Act, 42 USC 1320d et seq., and the
regulations promulgated thereunder at 45 CFR 160 and 164, to the extent those
regulations apply to the provider and the information that is contained within
DARTS.
d) The reimbursement limits herein shall not be applied in
situations where to do so would deny an eligible individual under age 21 from
receiving "early and periodic screening, diagnostic and treatment
services" (ESPSDT) as defined in 42 USC 1396d(r). With the exception of
adolescent residential rehabilitation as specified in Section 2090.40(c)(1) of
this Part, services as set forth in this Part shall be reimbursable to an
eligible individual under age 21 for as long as the services are clinically
necessary pursuant to review which is consistent with subsection (a) of this
Section. (The reimbursement limit for adolescent residential rehabilitation
services as set forth in Section 2090.40(c)(2) of this Part is not considered
to be a denial of required, early and periodic screening, diagnostic and
treatment services.)
e) The reimbursement limits herein shall not be applied where to
do so would deny services to a pregnant woman that have been determined to be
clinically necessary pursuant to review which is consistent with subsection
(a). This exemption from the limits exists during the pregnancy and through
the end of the month in which the 60-day period following termination of the
pregnancy ends (post partum period), or until the services are no longer
clinically necessary, whichever comes first. This exemption shall not apply to
a woman who enters treatment services after delivery.
f) The provider shall not be reimbursed for services delivered in
more than one Medicaid covered subacute alcoholism or other drug abuse level of
care per client per day except for ancillary psychiatric diagnostic services.
g) Group treatment in Level I and II care shall be reimbursed
only for up to 12 clients per group that are supported by any type of
Department contract funding.
(Source: Amended at 27 Ill.
Reg. 14022, effective August 8, 2003)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.40 REIMBURSABLE SERVICES
Section 2090.40
Reimbursable Services
a) Level
I: (formerly Outpatient Services)
1) Definition
The provision
of treatment services as defined in 77 Ill. Adm. Code 2060.401(b).
2) Reimbursement
Level I
treatment services delivered to clients are Medicaid-reimbursable via the
prospective rates in effect as of the date of service (89 Ill. Adm. Code 148.370).
Medicaid claims are submitted to the Department and shall meet the requirements
of IDPA rules for alcoholism and substance abuse treatment programs (89 Ill.
Adm. Code 148.340 through 148.370). The billable unit of service is a client
hour defined as face-to-face counseling with a diagnosed client in an
individual or group setting. Reimbursement shall occur by a fee-for-service
mechanism, using one client hour as the base unit of service, billable to the
nearest quarter-hour. No more than 25 hours may be reimbursed for an eligible
adult client per benefit year.
b) Level
II: (formerly Intensive Outpatient Services)
1) Definition
The provision
of treatment services as defined in 77 Ill. Adm. Code 2060.401(c).
2) Reimbursement
Level II treatment
services delivered to clients are Medicaid reimbursable via the prospective
rates in effect as of the date of service (89 Ill. Adm. Code 148.370).
Medicaid claims are submitted to the Department, and shall meet the
requirements of IDPA rules for alcoholism and substance abuse programs (89 Ill.
Adm. Code 148.340 through 148.370). The billable unit of service is a client
hour defined as face-to-face counseling with a diagnosed client in an
individual or group setting. Reimbursement shall occur by a fee-for-service
mechanism, using one client hour as the base unit of service billable to the
nearest quarter-hour. No more than 75 hours shall be reimbursed for an
eligible adult client per benefit year.
c) Level
III: (formerly Inpatient/Residential Services)
1) Definition-Adolescent Residential Rehabilitation
The provision
of treatment services as defined in 77 Ill. Adm. Code 2060.401(d). Such
treatment shall be for adolescents on a scheduled-only residential basis in a
Medicaid enrolled hospital subacute setting, or to adolescents in a psychiatric
facility or an inpatient program in a psychiatric facility, either of which is
accredited by the Joint Commission on Accreditation of Health Care
Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois
60181.
Adolescent
residential rehabilitation must be delivered in accordance with an adolescent's
individualized treatment plan recommended by a physician if in a hospital
setting, and under the direction of a physician if in a psychiatric facility.
2) Reimbursement
Adolescent
residential rehabilitation treatment services delivered to clients are medicaid
reimbursable via the prospective rates in effect as of the date of service (89
Ill. Adm. Code 148.370). Medicaid claims are submitted to the Department and
shall meet the requirements of IDPA rules for alcoholism and substance abuse
treatment programs (89 Ill. Adm. Code 148.340 through 148.370). Reimbursement
shall occur on a per diem basis. Through June 30, 2003, no more than 120 days
shall be reimbursed for an eligible client per benefit year.
3) Definition-Day Treatment
The provision
of treatment services as defined in 77 Ill. Adm. Code 2060.401(d). The
treatment shall be on a scheduled-only residential basis by a program licensed
pursuant to 77 Ill. Adm. Code 2060 and certified as having 16 beds or fewer as
specified in Section 2090.30 of this Part and excluding room and board, meals,
night supervision of dormitory areas and other domiciliary support services.
Treatment services may be provided to adults and adolescents.
4) Reimbursement
Day treatment
services delivered to clients are Medicaid reimbursable via the prospective
rates in effect as of the date of service (89 Ill. Adm. Code 148.370). Day
treatment services shall be reimbursed at a per diem rate. No more than 30
days shall be reimbursed for an eligible adult client per benefit year.
5) Definition - Medically Monitored Detoxification
The provision
of detoxification services as defined in 77 Ill. Adm. Code 2060.405(a). Such
services shall occur in a Medicaid enrolled hospital subacute setting or in a
residential program licensed pursuant to 77 Ill. Adm. Code 2060 and certified
as having 16 beds or fewer as specified in Section 2090.30 of this Part,
excluding room and board, meals, night supervision of dormitory areas and other
domiciliary services. The treatment shall be for individuals 18 years or older
(individuals who are 17 years old may be included provided that their
assessment includes justification based on behavior and life experience).
6) Reimbursement
Medically
monitored detoxification services delivered to clients are Medicaid
reimbursable via the prospective rates in effect as of the date of service (89
Ill. Adm. Code 148.370). Medicaid claims are submitted to the Department and
shall meet the requirements of IDPA rules for alcoholism and substance abuse
treatment programs (89 Ill. Adm. Code 148.340 through 148.370). Medically
monitored detoxification shall be reimbursed at a per diem rate. No more than
nine days shall be reimbursed for each eligible adult patient per benefit year.
d) Ancillary
Psychiatric Diagnostic Services
1) Ancillary psychiatric diagnostic services are limited
psychiatric evaluations to determine whether the client's primary condition is
attributable to the effects of alcohol or drugs or to a diagnosed psychiatric
or psychological disorder. Such an evaluation shall determine the client's
primary condition and recommend appropriate treatment services.
2) Reimbursable psychiatric evaluations are limited to a
psychiatric evaluation/examination of a client and the exchange of information
with the primary physician and other informants such as nurses, counseling
staff, or family members and the preparation of a report including psychiatric
history, mental status, and diagnosis. This service shall be performed by a
psychiatrist.
3) Reimbursable psychiatric evaluations may be delivered to
clients where the need for such services is documented in the client's
individualized treatment plan. Documentation of all such services shall be
maintained in the client record.
4) Ancillary diagnostic services delivered to clients are
Medicaid-reimbursable on a per-encounter basis at the practitioner's usual and
customary charge, not to exceed the prevailing rate as established by IDPA
pursuant to 89 Ill. Adm. Code 140.400.
(Source: Amended at 26 Ill.
Reg. 12631, effective August 1, 2002)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.50 QUALITY IMPROVEMENT
Section 2090.50 Quality
Improvement
Each provider shall have and
adhere to a quality improvement plan developed in compliance with the
provisions in 77 Ill. Adm. Code 2060.315.
(Source: Amended at 21 Ill. Reg. 1600, effective January 27, 1997)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.60 CLIENT RECORDS
Section 2090.60 Client
Records
Each provider shall maintain
client records in compliance with the provisions in 77 Ill. Adm. Code 2060.325.
(Source: Amended at 21 Ill. Reg. 1600, effective January 27, 1997)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.70 RATE SETTING
Section 2090.70 Rate Setting
a) The amount approved for payment for alcoholism and other drug
abuse treatment is based on the category and amount of services required by and
actually delivered to a client. The amount is determined in accordance with
prospective rates developed by the Department and adopted by the Department of
Public Aid. The adopted rate shall not exceed the charges to the general
public.
b) Rates are generated through the application of formal
methodologies specific to each reimbursable service as specified in Section
2090.40 of this Part.
(Source: Amended at 23 Ill. Reg. 13879, effective November 4, 1999)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.80 RATE APPEALS
Section 2090.80 Rate Appeals
a) Providers may appeal their rates in writing within 30 calendar
days of the postmark date of the rate notice.
b) Appeals shall be submitted to the Department.
c) The Department shall determine whether a reason for the appeal
exists pursuant to subsection (d) of this Section and that the written appeal
contains all elements required in subsection (e) of this Section. Further
clarification of the information submitted may be requested of the provider.
d) Rate appeals may be considered for the following reasons:
1) Mechanical or clerical errors committed by the provider in
reporting historical expenses used in the calculation of allowable costs.
2) Mechanical or clerical errors committed by the Department in
auditing historical expenses as reported and/or in calculating reimbursement
rates.
3) The Department and the provider have entered into a written
agreement to amend, alter, or modify substantive programmatic or management
procedures attendant to the delivery of services, which have a substantial
impact upon the costs of service delivery.
4) The Department has amended the licensed capacity of a facility
or treatment service.
5) The Department requires substantial treatment service changes
as a result of mandated licensure requirements.
6) The Department requires substantial changes in physical plant
as a result of mandated licensure requirements. In such instances, the
provider must submit a plan of corrections for capital improvements approved by
the licensing authority, along with the required cost information.
7) State and/or federal regulatory requirements have generated a
substantial increase in allowable costs.
e) To be accepted for review, the written appeal shall include:
1) The current approved reimbursement rate, allowable costs, and
the additional reimbursable costs sought through the appeal;
2) A clear, concise statement of the basis for the appeal;
3) A detailed statement of financial, statistical, and related
information in support of the appeal, indicating the relationship between the
additional reimbursable costs as submitted and the circumstances creating the
need for increased reimbursement;
4) A citation to any mandated or contractual requirement
pertinent to the appeal; and
5) A statement by the provider's chief executive officer or
financial officer that the application of and information contained in the
vendor's reports, schedules, budgets, books and records submitted are true and
accurate.
(Source: Amended at 23 Ill. Reg. 13879, effective November 4, 1999)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.90 INSPECTIONS
Section 2090.90 Inspections
a) The Department shall conduct inspections of applicants for
program certification or recertification and of certified programs to enforce
compliance with this Part. Department inspections may be conducted as part of
the certification/recertification application process, on a random basis to
survey compliance with this Part, or in response to complaints, if the
complaint sets forth charges that constitute grounds for sanction pursuant to
Section 2090.100.
b) Upon presentation of Department credentials, inspectors of the
Department shall be permitted access to inspect all physical facilities and
records of the program and to make inquiries of program staff and clients.
(Source: Old Section 2090.90 repealed and Section 2090.105 renumbered to
Section 2090.90 and amended at 21 Ill. Reg. 1600, effective January 27, 1997)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.100 SANCTIONS FOR NON-COMPLIANCE/AUDITS
Section 2090.100 Sanctions
for Non-Compliance/Audits
a) Failure to comply with the requirements of this Part shall
result in the provider being issued a written warning or having its
certification suspended or terminated for the Illinois Medical Assistance
Program.
b) The Department shall issue written notification to a certified
provider who has failed to comply with any provision specified in this Part.
The provider shall have a maximum of 60 calendar days from the date of the
written notice to correct the cited deficiencies. However, such action shall not
preclude the Department from initiating proceedings as specified in subsection
(g) of this Section.
c) The Department may also conduct post-payment audits based on
volume of billings, complaints, identified deficiencies or non-compliance with
this Part, or pursuant to a random selection process as necessary to monitor
for compliance with this Part.
d) The Department shall audit a statistically significant
randomly selected sampling of client records at the audited program.
e) The Department shall follow the recoupment formula approved by
the Department of Public Aid, should the audit result in recoupment.
f) Upon completion of the post-payment audit the Department shall
submit written notification to the program regarding audit findings and amounts
determined to be recoupable. The program shall respond to the notification
within 15 days with supporting documentation regarding the recoupment amount.
If such documentation proves that the recoupment amount is inaccurate, the
amount shall be revised. The program may also request a 100% audit. The
department may reduce future payments at a percentage per month or in a lump
sum, or demand repayment in a lump sum.
g) The Department and the Department of Public Aid shall jointly
initiate administrative proceedings pursuant to 89 Ill. Adm. Code 140.16 to
suspend or terminate certification and eligibility to participate in the
Illinois Medical Assistance Program for reasons set forth in 89 Ill. Adm. Code
140.16 or for failing to comply with any provision of this Part. The
Department may also initiate administrative proceedings pursuant to 89 Ill.
Adm. Code 140.15 to recover money. Both types of proceedings shall be conducted
under 89 Ill. Adm. Code 104: Subpart C (Rules of Practice for Medical Vendor
Hearings).
(Source: Amended at 23 Ill. Reg. 13879, effective November 4, 1999)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.105 INSPECTIONS (RENUMBERED)
Section 2090.105 Inspections
(Renumbered)
(Source: Section 2090.105 renumbered to Section 2090.90 at 21 Ill. Reg.
1600, effective January 27, 1997)
| TITLE 77: PUBLIC HEALTH
CHAPTER X: DEPARTMENT OF HUMAN SERVICES
SUBCHAPTER g: MEDICAID PROGRAM STANDARDS
PART 2090
SUBACUTE ALCOHOLISM AND SUBSTANCE ABUSE TREATMENT SERVICES
SECTION 2090.110 SANCTIONS FOR NON-COMPLIANCE/AUDITS (RENUMBERED)
Section 2090.110 Sanctions
for Non-Compliance/Audits (Renumbered)
(Source: Section 2090.110 renumbered to Section 2090.100 at 21 Ill. Reg.
1600, effective January 27, 1997)
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