Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart L - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Table N - Program Approval for Specified Behavioral Health Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) Purpose. Services requiring program
				approval, as required in Section
				140.453,
				shall be approved based upon the criteria outlined in this Section. For the
				purposes of this Section, Department shall mean the Department of Healthcare
				and Family Services (HFS) or its agent.
b) Process
1) Initial Program Approval
A) Enrolled providers, and providers seeking
				enrollment with HFS pursuant to Section
				140.452,
				to provide one or more of the services detailed in Section
				140.453
				that require program approval, must identify their intention to provide those
				services with the HFS Provider Participation Unit through the Illinois Medicaid
				Program Advanced Cloud Technology (IMPACT) portal.
B) The Department shall process the
				provider's enrollment application, or updated materials, pursuant to Subpart
				B.
C) Following the provider's
				enrollment, or updated enrollment status, the Department will perform program
				approval of the provider's service program within 90 days.
D) The program approval process shall
				include:
i) The annual submission of an
				attestation detailing the provider's adherence with Section
				140.453
				and this Table N, for each service for which the provider is seeking program
				approval.
ii) The review of
				provider program plans, policies, procedures, staffing materials, and other
				documents required by the Department to determine compliance with Section
				140.453
				and this Table N, for each service for which the provider is seeking program
				approval.
iii) Program approval of
				PSR and IO service programs shall require an on-site visit prior to
				approval.
iv) The Department may,
				at its sole discretion, elect to perform on-site program approval activities
				for any and all services detailed in this Table N.
E) The Department will notify the provider of
				the date and format of its program approval activities in writing. For program
				approval activities that are subject to on-site review, the Department will
				notify the provider at least 10 days prior to the scheduled review. The
				Provider must:
i) Make the physical plant and
				site locations available to the Department during clinical review;
ii) Make all administrative and clinical
				staff, required program plans, procedures manuals, and other necessary
				documentation required to complete the program approval review available to the
				Department during the review.
F) The Department shall utilize the program
				approval criteria detailed in subsection (c) of this Table N for each of the
				qualifying service program types to be reviewed.
G) Following the on-site review, the
				Department shall notify the provider in writing, within 10 business days, of
				its program approval findings.
i) Providers
				determined to be approved shall be enrolled for a period of 12 months for the
				service program specialty in IMPACT.
ii) Providers determined not to be approved:
* May request programmatic technical assistance from the
				  Department. Throughout the period of receiving technical assistance, and at the
				  sole discretion of the Department, the Department may work jointly with the
				  provider to remedy outstanding issues and approve the provider's
				  program.
* Providers determined not to be approved shall be notified
				  of their rights to appeal pursuant to subsection (e), following the receipt of
				  technical assistance from the Department.