Ill. Admin. Code tit. 59 § 132.105

Current through Register Vol. 48, No. 45, November 8, 2024

Section 132.105 - Certification Review Cycle

a) The CSA may perform a review for compliance with the standards of this Part at any CSP or CMHC, at will, regardless of deemed status and without prior notice to the entity.

b) The CSAs shall, at a minimum, review one-third of all CSPs and CMHCs on an annual basis, ensuring that all CSPs and CMHCs are reviewed within a three year period. If the CSA determines the entity to be:

1) In compliance with Subparts B, C and D, the CSA shall notify the entity of retention of certification. For entities enrolled in the IMPACT system, the CSA shall notify HFS of retention of certification.

2) Not in compliance, the CSA shall issue the entity a Notice of Violation within 15 days after the on-site review. The entity shall respond to the NOV by the due date indicated on the NOV, which shall be approximately 30 days after the date of the NOV.

A) The entity shall submit a Plan of Correction to the CSA to address all identified violations by the due date indicated on the NOV.

B) If the Plan of Correction is found to address all of the identified violations included in the NOV, the CSA shall assure implementation of the Plan of Correction, which will determine the certification status. The program certification status must be in "good standing" with the CSA. The CSA shall notify the entity of retention of certification. For an entity enrolled in IMPACT, the CSA shall also notify HFS of the entity's retention of certification.

c) If the entity fails to supply the necessary materials or the supplied materials fail to meet the standards detailed in Subparts B, C and D, the CSA shall notify the entity of its failure to retain certification and the right to appeal pursuant to Section 132.340. For entities enrolled in IMPACT, the CSA shall also notify HFS in writing of the entity's failure to retain certification.

d) If the CSA finds evidence of suspected fraud or abuse relating to Medical Assistance, the CSA shall refer that evidence to HFS Office of Inspector General for further action.

e) Revocation of Certification

1) The CSA may revoke an entity's certification at any time for any of the following reasons:

A) The entity meets any of the grounds for termination set forth in 89 Ill. Adm. Code 140.16;

B) The entity is convicted of defrauding the Medical Assistance Program under Article VIIIA of the Illinois Public Aid Code; or

C) The entity fails to comply with the requirements of Subpart B, C or D.

2) The CSA shall notify the entity in writing of the entity's revocation of certification and right to appeal pursuant to Section 132.110. For providers enrolled in the IMPACT system, the CSA shall notify HFS.

Ill. Admin. Code tit. 59, § 132.105

Adopted at 43 Ill. Reg. 1049, effective 1/1/2019