Current through Register Vol. 48, No. 12, March 22, 2024
a) In order to qualify for certification as a
provider of CCP services, a provider agency must, to the satisfaction of the
Department, meet the following administrative requirements:
1) Serve an entire CCP geographic area.
A) Other than in Cook County, the geographic
area will be the county.
B) In Cook
County outside the City of Chicago, the geographic area will be the
township.
C) Within the City of
Chicago, the geographic area will be the following subareas, defined by Zip
Code:
i) 60626, 60640, 60645, 60659,
60660
ii) 60625, 60630, 60631,
60646, 60656
iii) 60634, 60639,
60641
iv) 60613, 60614, 60618,
60647, 60657
v) 60601, 60602,
60603, 60604, 60605, 60606, 60607, 60610, 60611, 60622, 60642, 60654,
60661
vi) 60615, 60616, 60637,
60649, 60653
vii) 60609, 60623,
60629, 60632, 60638
viii)
60619
ix) 60620, 60621, 60636,
60643, 60652, 60655
x) 60608,
60612, 60624, 60644, 60651.
xi)
60628
xii) 60617, 60633,
60827.
2) The
Department reserves the right to adjust this geographic area requirement to
assure that:
A) no geographic area remains
unserved.
B) the following entities
are not excluded from participation as service providers in the CCP:
i) entities serving limited- or
non-English-speaking participants;
ii) providers that are, or are controlled by,
a unit of local government and cannot operate outside the jurisdiction of that
local government; and
iii) regional
benevolent, charitable, social or religious organizations that have as their
charter providing services to a specific population or geographic area smaller
than a county, township or CCP subarea.
C) transportation to/from adult day service
facilities can be completed in a reasonable period of time.
3) Submit a request for
certification providing the information described in this Section and Sections
240.1600 and
240.1605,
in the form and manner prescribed by the Department, including all required
supporting compliance material or other information documenting its
administrative and operational ability, and institute all necessary action
based on the outcome of the Department's review.
4) Document the legal structure under which
it is organized to do business as set forth in Section
240.1607(h).
5) Provide a list of the directors, officers
or owners, as applicable to the legal structure of the provider
agency.
6) Verify experience in
providing service comparable to the CCP, as defined in Sections
240.210,
240.230,
240.235
and
240.237,
for which certification is requested, and that is consistent with the
requirements set forth in this Part.
A)
Required Experience
i) For prospective
emergency home response service provider agencies: A minimum of 5 years
experience in business operations providing emergency home response
service.
ii) For prospective adult
day service provider agencies: A minimum of 2 years experience providing direct
social services programming.
iii)
For prospective in-home service providers: A minimum of 3 years experience in
business operations providing in-home service, one of which must be in
Illinois.
iv) For prospective AMD
service provider agencies: a minimum of 5 years experience in business
operation providing AMD services.
B) The Department reserves the right to:
i) adjust the experience requirements
specified in subsection (a)(6)(A) if the provider agency submits proof of
current accreditation or certification by an appropriate national organization
for the service for which Department certification is being
requested.
ii) issue provisional
certification to provider agencies, including, but not limited to, those that
have not previously been certified or are not in operation at the time the
application is made. The provisional certification shall not exceed two years
and the Department will conduct additional oversight during the provisional
period to protect participant health, safety and welfare.
iii) adjust the experience requirement (e.g.,
substituting management team experience for agency experience) when it is in
the best interests of the CCP. The Department will continue to assure that any
adjustment of the experience requirement will occur only when the health,
safety and welfare of CCP participants and the quality of services provided
will not be adversely affected.
7) Disclosure of information regarding past
business practices of the provider agency and its affiliates, including the
managers, directors or owners, relevant to the service applied for, involving,
but not limited to, the following circumstances:
A) denial, suspension, revocation or
termination for cause of a license or Provider Agreement, or any other
enforcement action, such as civil court or criminal action;
B) termination of a Provider Agreement or
surrender of a license before expiration or allowing a contract or a license to
expire in lieu of enforcement action;
C) any federal or state Medicaid or Medicare
sanctions or penalties relating to the operation of the agency, including, but
not limited to, Medicaid abuse or fraud;
D) any federal or state civil or criminal
felony convictions;
E) operation of
an agency that has been decertified in any state under Medicare or Medicaid;
or
F) citations for participant
abuse, neglect, injury, financial exploitation or inadequate care in any
state.
8) Document its
written policies and procedures in compliance with the applicable
administrative standards imposed on provider agencies under the CCP, as set
forth in Section
240.1510.
9) Document its ability to comply with all
applicable responsibilities imposed on provider agencies under the CCP, as set
forth in Section
240.1520,
including proof of required insurance coverages.
10) Submit audited financial reports from the
last complete business fiscal year, unless the provider agency is a newly
established business entity.
A) Newly
established for profit business entities, regardless of relationship to any
other provider agency, shall:
i) submit proof
that employee tax accounts are restablished with the State of Illinois and the
U.S. Treasurery; and
ii) submit
either:
* a bank approved business plan with approved financial
backing; or
* if financial resources are from individuals, the most
recent 2 years of tax returns, as well as any bank approved individual
financial backing for use in the business.
B) Newly established not-for-profit business
entities, regardless of relationship to any other provider agency, shall
submit:
1) Bank approved business plan with
approved financial backing or a signed financial statement illustrating
restricted and nonrestricted funding; and
2) Proof that employee tax accounts are
established with the State of Illinois and the U.S. Treasury.
11) Submit proof that
it is fiscally sound, as that term is defined in Section
240.160, by
verifying assets (e.g., audited financial statements with accompanying notes,
bank statements, investment statements, or letters of credit from financial
institutions) sufficient to cover 90 days of operating expenses for the service
line applied for (i.e., specifically ADS, In-Home Services, EHRS or AMD), as
defined by the agency business plan. No more than 30 of the 90 days should be
based on a line of credit.
12)
Provide assurance that its business operations comply with the service,
staffing and training requirements imposed on provider agencies under this
Part.
13) Provide a minimum of 5
references from such entities as persons who have been served by the provider,
nonprofit or business organizations or governmental bodies that have observed
the operations and/or services of the provider, employees of the provider, an
Area Agency on Aging, etc., attesting to the provider agency's qualifications
relevant to providing CCP services. The references shall be from a diverse
group of knowledgeable entities.
14) Comply with all applicable federal, State
and local laws, regulations, rules, service standards and policies or
procedures pertaining to the provider agency in its business operations and to
the services provided under the CCP.
b) If a provider agency is not able or is
unwilling to meet the administrative requirements in subsection (a), the
Department shall deny its request for certification.
c) The Department reserves the right to
accept documentation of Illinois Department of Public Health (DPH) home service
licensure for applicable administrative requirements. (See 77 Ill. Adm. Code
245. Subpart B.)