Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart J - ALTERNATE PAYEE PARTICIPATION › Section 140.1001 - Registration Conditions for Alternate Payees

Current through Register Vol. 48, No. 28, July 12, 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.