Section 240.1580  Standards for Alternative Providers

a)         In the event that CCP services are not provided to an eligible participant within the time limit specified in Section 240.910, the eligible participant may arrange to receive CCP in-home services from an individual or a home care agency of the eligible participant's choice 15 calendar days after the date of the notice of eligibility. The CCU shall approve the participant's choice of individual or home care agency for in-home services to be provided.

b)         If there is an interruption of services provided to a participant due to the failure of a contractual provider to provide those services, the CCU shall assist the participant in locating an individual or home care agency.

c)         The Department shall authorize the individual or home care agency and shall guarantee a minimum of 15 calendar days of service provided by the alternative provider, if at the request of the alternative provider. A home care agency whose previously held CCP contract was terminated for cause shall not be authorized as an alternative provider.

d)         The Department shall make payment on a monthly basis for the services at the rate that would have been paid an individual provider, if an individual is selected by the eligible participant; or at the usual and customary rate of the home care agency/provider chosen by the eligible participant to provide this service, if a home care agency is selected by the eligible participant.

e)         Payment shall continue in accordance with subsection (c), and only until the Department's contractual provider initiates provision of CCP services to the participant, at which time service by the alternative provider shall be immediately terminated. The CCU shall verbally notify the alternative provider and the participant of the date upon which service shall be initiated by the Department's contractual provider.

f)         Request for payment for services rendered by an individual alternative provider shall be submitted to the Department by the individual providing the service.

g)         Payment for services rendered by a home care agency of the eligible participant's choice shall be made by the Department following submittal by the agency and processing by the Department of billing forms provided to the agency by the Department.

h)         Payment shall be authorized in compliance with the State Prompt Payments Act [30 ILCS 540].

i)          The Department shall be liable for its share of the cost of CCP services, as determined in accordance with Sections 240.855 and 240.870.

j)          The payment for the monthly expense for care incurred by the participant for CCP alternative provider services shall be the responsibility of the participant as set forth in Section 240.875.

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