Current through Register Vol. 48, No. 38, September 20, 2024
a) In order to participate, alternate payees
must meet the following conditions:
1) Hold a
valid, appropriate license when State law requires licensure of medical
practitioners, agencies, institutions and other medical entities;
2) Be certified for participation in the
Title XVIII Medicare program when federal or State rules and regulations
require certification for Title XIX participation;
3) Be certified for Title XIX when federal or
State rules and regulations so require;
4) Qualify as:
A) Hospital or a hospital affiliate as
defined by the Hospital Licensing Act [210 ILCS 85 ];
B) Professional school that offers a degree
to qualify individuals for licensure to perform medical services;
C) Group practice solely owned by three or
more full-time licensed individual practitioners who are eligible to
participate in the Medical Assistance Program;
D) Partnership that requires fees of its
partners to be turned over to the partnership and all partners are eligible to
participate in the Medical Assistance Program;
E) Individual practitioner "employer" who
requires an employee, as a condition of employment, to turn over his or her
fees to the employer. The employer must be eligible to participate in the
Medical Assistance Program. An employer who qualifies as a payee for more than
four practitioners, and an employer who is not licensed in the same profession
as the practitioners in his or her employ who have designated the employer as
the alternate payee, shall be subject to enhanced screening and verification by
the Inspector General of the Department, except when an advanced practice nurse
licensed under the Nurse Practice Act [225 ILCS 65 ] designates an employer who
is a physician licensed under the Medical Practice Act of 1987 [225 ILCS 60
];
F) Corporation registered with
the Illinois Secretary of State's Office to do business in the State of
Illinois. A corporation registered with the Illinois Secretary of State's
Office to do business in the State of Illinois, whose shares of ownership are
not publicly traded in a recognized stock exchange within the United States of
America, shall be subject to enhanced screening and verification by the
Inspector General of the Department;
G) Governmental entity that requires, as a
condition of employment, that the fees be turned over to the governmental
entity;
H) Community mental health
agency that is certified by the Department of Human Services under 59 Ill. Adm.
Code 132 and is enrolled as a provider in the Medical Assistance Program;
or
I) Federally Qualified Health
Center, Rural Health Center or Encounter Rate Clinic that is enrolled as a
provider in the Medical Assistance Program;
5) Provide registration information to the
Department, in the prescribed format;
6) Notify the Department, in writing,
immediately whenever there is a change in any information that the alternate
payee has previously submitted;
7)
Provide disclosure, as requested by the Department, of all financial,
beneficial, ownership, equity, surety, or other interests in any and all firms,
corporations, partnerships, associations, business enterprises, joint ventures,
agencies, institutions, or other legal entities providing any form of health
care services to public assistance recipients and alternate payee
relationships; and
8) Have a
current alternate payee registration on file with the Department.
b) Approval of a corporate entity
such as a group practice, a partnership, hospital, or professional school as an
alternate payee in the Medical Assistance Program applies only to the entity's
existing ownership, corporate structure, and location. Therefore, an alternate
payee's registration in the Medical Assistance Program is not
transferable.
c) For purposes of
administrative efficiency, the Department may periodically require classes of
alternate payees to re-register in the Medical Assistance Program. Under the
re-registration, the Department shall request classes of alternate payees to
submit updated information. Failure of an alternate payee to submit updated
information within the requested time frames may result in cancellation of the
alternate payee registration from the Program. The cancellation shall have no
effect on the future eligibility of the alternate payee to participate in the
Program and is intended only for purposes of the Department's efficient
administration of the Program.
d)
For purposes of this Section, an alternate payee whose alternate payee investor
ownership has changed by 50 percent or more from the date the alternate payee
was initially approved for registration as an alternate payee in the Medical
Assistance Program shall be required to submit a new application for
registration. All applications must meet the requirements for
registration.
