Illinois Administrative Code › Title 68 - PROFESSIONS AND OCCUPATIONS › Part 1253 - HOME MEDICAL EQUIPMENT AND SERVICES PROVIDER ACT › Section 1253.20 - Application for Licensure

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 Entities applying for licensure as a home medical equipment and services
			 provider shall file an application with the Department, on forms provided by
			 the Department. The application shall include the following:
1) The name, location (including street,
			 city, state (no post office box)) and telephone number of the
			 applicant;
2) Certification of
			 insurance from the insurer showing $1,000,000 of commercial general liability
			 insurance, including but not limited to coverage for products liability and
			 professional liability;
3) All
			 trade or business names used by the applicant;
4) A list of categories of services
			 provided;
5) Medicare
			 Identification Number (if applicable);
6) Name of the person in charge of the day to
			 day operation of the business;
7)
			 The type of ownership or operation (i.e., partnership, limited liability
			 company, corporation or sole proprietorship). If a corporation, a copy of the
			 articles of incorporation;
8) The
			 name of the owner and/or operator of the entity, including:
A) The name of the person, if a
			 person;
B) The name of each partner
			 and the name of the partnership, if a partnership;
C) The name and title of each corporate
			 officer and director, the corporate names, the name of the state where
			 incorporated and the name of the parent company, if any, if a
			 corporation;
D) The full name of
			 the sole proprietor and the name of the business entity, if a sole
			 proprietorship; or
E) The full name
			 and title of each member with 5% or more ownership and each manager of a
			 limited liability company and the name of the state where organized and a copy
			 of the articles of organization and the name of any parent company, if
			 any;
9) The fee set
			 forth in Section
			 1253.70 of this
			 Part;
10) Certification, signed by
			 an authorized representative of the entity, indicating that the business:
A) maintains a physical facility and a
			 medical equipment inventory;
B)
			 maintains records of education, training and experience and annual continuing
			 education for personnel engaged in the delivery, maintenance, repair, cleaning,
			 inventory control and financial management of home medical equipment and
			 services;
C) maintains records on
			 all patients to whom it provides home medical equipment and services that
			 include any training, education and other information pertinent to the use and
			 maintenance of equipment or the services provided. Patients' records shall
			 include, but not be limited to, name of patient and address, type of service
			 provided, payer requirements and other pertinent information for the service
			 level or specific product provided. The provider shall have adequate security
			 measures to maintain confidential records;
D) establishes and maintains equipment
			 management and personnel policies such as, but not limited to, security
			 operation, tracking and maintenance of equipment, customer service
			 complaints;
E) complies with State
			 and federal laws applicable to the type of services provided; and
F) provides access to emergency services 24
			 hours a day, 7 days a week for life sustaining home medical equipment and
			 services.