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DHS59 ILLINOIS ADMINISTRATIVE CODE 132132.25(RN) licensed under the Nurse Practice Act [225 ILCS 65] with at least one yearof clinical experience in a mental health setting or who possesses a master'sdegree in psychiatric nursing; or an occupational therapist (OT) licensed under theIllinois Occupational Therapy Practice Act [225 ILCS 75] with at least one yearof clinical experience in a mental health setting.Licensed Practitioner of the Healing Arts or LPHA An Illinois licensed healthcare practitioner who, within the scope of State law, has the ability toindependently make a clinical assessment, certify a diagnosis and recommendtreatment for persons with a mental illness and who is one of the following: aphysician; an advanced practice nurse with psychiatric specialty licensed underthe Nurse Practice Act [225 ILCS 65]; a clinical psychologist licensed under theClinical Psychologist Licensing Act [225 ILCS 15]; a licensed clinical socialworker (LCSW) licensed under the Clinical Social Work and Social WorkPractice Act [225 ILCS 20]; a licensed clinical professional counselor (LCPC)licensed under the Professional Counselor and Clinical Professional CounselorLicensing Act [225 ILCS 107]; or a licensed marriage and family therapist(LMFT) licensed under the Marriage and Family Therapist Licensing Act [225ILCS 55] and 68 Ill. Adm. Code 1283.Medicaid Medical assistance authorized by HFS under the provisions of theIllinois Public Aid Code [305 ILCS 5/Art. V], the Children's Health InsuranceProgram Act [215 ILCS 106] and Titles XIX and XXI of the Social Security Act(42 USCA 1396 and 1397aa).Medical Necessity or Medically Necessary A mental health intervention ismedically necessary if:the individual has a diagnosis of mental illness or serious emotionaldisorder as defined in ICD-9-CM or DSM-IV;mental health services are identified as appropriate to the individual'sneeds as identified in a mental health assessment; andthe intervention could not have been omitted without adversely affectingthe individual's functioning.The LPHA shall recommend that medical or remedial services are necessaryto reduce the physical or mental disability of an individual and to restore anindividual to the maximum possible functioning level. A service is notmedically necessary if it is provided solely for the convenience of theindividual, his or her family or the provider.

DHS59 ILLINOIS ADMINISTRATIVE CODE 132132.25Mental Health Professional or MHP An individual who provides services underthe supervision of a qualified mental health professional and who possesses: abachelor's degree; a practical nurse license under the Nurse Practice Act [225ILCS 65]; a certificate of psychiatric rehabilitation from a DHS-approvedprogram plus a high school diploma plus 2 years experience in providing mentalhealth services; a recovery support specialist certified and in good standing withthe Illinois Alcohol and Other Drug Abuse Professional Certification Association,Inc., plus one year experience in providing mental health services; anoccupational therapy assistant licensed under the Illinois Occupational TherapyPractice Act [225 ILCS 75] with at least one year of experience in a mental healthsetting; or a minimum of 5 years supervised experience in mental health or humanservices. A supervised internship in a mental health setting counts toward theexperience in providing mental health services. Any individual meeting theminimum credentials for an LPHA or QMHP under this Part is deemed to alsomeet the credentialing requirements of an MHP.Mental Illness A mental or emotional disorder diagnosis contained in the DSMIV or ICD-9-CM, authorized by the public payer funding the services under thisPart and the condition that will be the main focus of treatment for services underthis Part. Mental illness does not include organic disorders such as dementia andthose associated with known or unknown physical conditions such as hallucinosis,amnestic disorder and delirium; psychoactive substance induced organic mentaldisorders; and mental retardation or psychoactive substance use disorders.Natural Setting A setting where an individual not identified as mentally illtypically spends time, including home, school, work, churches, communitycenters, libraries, parks, recreation centers, etc. These sites are not licensed,certified or accredited as a treatment setting nor typically identified as treatmentsites.Off-site Locations other than a certified provider site as described in Section132.90. A place of residence that is owned or leased by a provider and occupiedby a client also will be considered off-site unless there is a certified site connectedto the residence.On-site Location that is a certified provider site as described in Section 132.90.Part 132 Services The community mental health services described in this Part.Physician A physician licensed under the Medical Practice Act of 1987 [225ILCS 60] to practice medicine in all its branches.Provider An entity certified to provide Medicaid community mental health

DHS59 ILLINOIS ADMINISTRATIVE CODE 132132.25services in accordance with this Part.Public Payer HFS, a State agency or a unit of local government that isresponsible for payment for services under this Part provided to a client pursuantto a contract with the provider.Qualified Mental Health Professional or QMHP One of the following:A licensed social worker (LSW) possessing at least a master's degree insocial work and licensed under the Clinical Social Work and Social WorkPractice Act [225 ILCS 20] with specialized training in mental healthservices or with at least 2 years experience in mental health services;A licensed professional counselor possessing at least a master's degree andlicensed under the Professional Counselor and Clinical ProfessionalCounselor Licensing Act [225 ILCS 107] with specialized training inmental health services or with at least two years experience in mentalhealth services;A registered nurse (RN) licensed under the Nurse Practice Act [225 ILCS65] with at least one year of clinical experience in a mental health settingor who possesses a master's degree in psychiatric nursing;An occupational therapist (OT) licensed under the Illinois OccupationalTherapy Practice Act [225 ILCS 75] with at least one year of clinicalexperience in a mental health setting; orAn individual possessing at least a master's degree in counseling andguidance, rehabilitation counseling, social work, vocational counseling,psychology, pastoral counseling, or family therapy or related field, whohas successfully completed a practicum or internship that included aminimum of 1,000 hours of supervised direct service, or who has one yearof clinical experience under the supervision of a QMHP.Any individual meeting the minimum credentials for an LPHA under this partis deemed to also meet the credentialing requirements of a QMHP.Rehabilitative Services Associate or RSA An RSA must be at least 21 years ofage, have demonstrated skills in the field of services to adults or children, havedemonstrated the ability to work within the provider's structure and acceptsupervision, and have demonstrated the ability to work constructively with clients,treatment resources and the community. Any individual meeting the minimum

DHS59 ILLINOIS ADMINISTRATIVE CODE 132132.25credentials for an MHP, QMHP or LPHA under this Part is deemed to also meetthe credentialing requirements of an RSA.SASS A program of intensive mental health services provided by an agencycertified to provide Part 132 services and under contract to provide screening,assessment and support services to children with a mental illness or emotionaldisorder who are at risk for psychiatric hospitalization.Specialized Substitute Living Arrangement A living arrangement providingservices to a client supervised by a provider licensed under the Child Care Act of1969 [225 ILCS 10] or any comparable Act in another state when the provider isunder contract to the State agency.State Agency Department of Healthcare and Family Services, Department ofJuvenile Justice, Department of Human Services, Department of Children andFamily Services or the Department of Corrections.Unit of Local Government A county, municipal corporation, or other localgovernment entity organized under the laws of the State of Illinois that, pursuantto an executed intergovernmental agreement with HFS, has agreed to pay forMedicaid community mental health services.(Source: Amended at 32 Ill. Reg. 9981, effective July 1, 2008)Section 132.30 Application, Certification and Recertification Processesa)A State agency, subject to an executed interagency agreement with HFS in itscapacity as the Medicaid State agency for Illinois, is authorized to perform thefunctions ascribed under this Part.b)Any entity having a contract with a State agency for the provision of mentalhealth services, other than hospital inpatient or hospital outpatient psychiatricservices, with DCFS for the provision of child welfare services, with DCFS orDHS for the provision of youth services, or with DOC for the provision of youthtreatment, rehabilitative or transitional services may apply for certification as aprovider. Applicants who meet the requirements of this Part will be certified byone of the State agencies and enrolled as a provider in the Illinois medicalassistance program by HFS pursuant to 89 Ill. Adm. Code 140.11. Providers willbe certified by, and subject to, Medicaid certification review by only one Stateagency. Providers who are certified to provide comparable Medicaid services inother states may apply to a State agency for reciprocity consideration andenrollment. Providers applying for reciprocity consideration and enrollment will

DHS59 ILLINOIS ADMINISTRATIVE CODE 132132.30be subject to the same standards as those providers applying for certificationunder this Part.c)Applications may be obtained by submitting a request in writing to:Illinois Department of Human ServicesBureau of Accreditation, Licensure and Certification401 North Fourth StreetSpringfield, Illinois 62702orIllinois Department of Children and Family ServicesOffice of Medicaid Certification406 East Monroe StreetSpringfield, Illinois 62701orIllinois Department of CorrectionsOffice of Medicaid Certification1301 Concordia CourtSpringfield, Illinois 62794-9277d)The applicant shall submit to DHS, DCFS or DOC a completed "Application forCertification of Medicaid Community Mental Health Services Programs" with allof the required accompanying components, as specified on the application form.An applicant shall submit its application to the Certifying State Agency that itintends to contract with for Part 132 services.1)If an applicant intends to contract for Part 132 services with more than oneState agency, the applicant shall submit its application to the State agencythat provides the most funding for those Medicaid community mentalhealth services.2)If the funding from the Certifying State Agencies is equal, the applicantshall submit the application to DHS.3)The application shall request information including, but not limited to:A)Applicant name and corporate status;B)List of services the applicant is requesting be certified;

DHS59 ILLINOIS ADMINISTRATIVE CODE 132C)e)132.30Description of how each service to be certified fits into theprograms of the applicant and other evidence of compliance withspecific service definitions (see Section 132.150):i)For Psychosocial Rehabilitation, the applicant must submita work week schedule for each site, demonstrating 25 hoursof available PSR and the name of the staff at each locationwho has co-occurring training or experience;ii)For Assertive Community Treatment, the applicant mustsubmit the names of staff on each team, indicating theircredentials and their role on the team, e.g., person inrecovery, experience in co-occurring disorders, and the timeworked each week; andiii)For Community Support Team, the applicant must submitthe names of staff on each team, indicating their credentialsand their role on the team, and the amount of time that eachstaff works on the team weekly;D)List of sites to be certified and the services to be provided at eachsite;E)Fire, electrical and plumbing clearances for each site, pursuant toSection 132.90;F)The address of all accessible sites;G)A staffing roster including staff qualifications and supervisoryresponsibilities for each of the sites;H)Policies on confidentiality and third-party payments;I)Utilization review plan; andJ)Medicare certification status.If the application form and all of the required components are in compliance withthis Part, the State agency shall issue to the provider a certificate for the Medicaidcommunity mental health services program.

DHS59 ILLINOIS ADMINISTRATIVE CODE 132f)132.301)An applicant that submits an application that is not in compliance with thisPart shall receive a Notice of Deficiencies. The Certifying State Agencyshall issue the Notice of Deficiencies within 30 days after receiving theapplication. If the applicant intends to proceed with applying forMedicaid certification, the applicant shall submit corrected documentationto address all of the deficiencies. The applicant shall submit the correcteddocumentation to the Certifying State Agency that received the applicationand issued the Notice of Deficiencies.2)The State agency shall issue the certificate within 30 days after theCertifying State Agency receives the completed application and allrequired components, including corrected documentation, if applicable.The effective date of certification shall be the date that the application or,if required, corrected documentation was approved. The Certifying StateAgency shall also send the Medicaid enrollment forms to the provider.The provider shall complete the enrollment forms for each certified site toenroll those sites in the Illinois medical assistance program.Certification shall be for a 3-year period.1)A provider shall deliver only mental health services under this Part forwhich it is certified.2)Any changes during the certification period that affect the ability of theprovider to deliver services in compliance with the requirements of thisPart shall be reported to the Certifying State Agency.3)A provider is expected to provide Psychosocial Rehabilitation (PSR),Assertive Community Treatment (ACT), Community Support Residential(CSR) and Community Support Team (CST) services within 90 days afterbeing notified of certification for the services. If the service is notimplemented within 90 days, the provider must show compliance with therequirements in subsection (p) before the Part 132 services can beprovided.4)If a provider has been certified for PSR, ACT, CSR or CST and decides tono longer provide the services, the provider shall notify the CertifyingState Agency at least 60 days prior to discontinuing the services. Theservice may be subject to removal from the certificate. Prior todiscontinuing the service, the provider shall provide a plan fortransitioning consumers to other services or to other providers.5)The provider shall submit team rosters for ACT and CST upon public

DHS59 ILLINOIS ADMINISTRATIVE CODE 132132.30payer request.g)Within 12 months after the date of initial certification, the Certifying StateAgency shall conduct a review.1)At the review, the Certifying State Agency shall evaluate the provider'scompliance with this Part.2)If no deficiencies are noted at the review, the Certifying State Agencyshall notify the provider of the results within 30 days after the completionof the review. Compliance reviews for recertification shall be conductedon or about the expiration date of the current certification period.3)If deficiencies are noted at the review, the Certifying State Agency shallreport those deficiencies to the provider during an exit conference. TheCertifying State Agency shall also issue a Notice of Deficiencies, returnreceipt requested, to the provider within 30 days after the completion ofthe review.4)If the Certifying State Agency issues a Notice of Deficiencies to theprovider, the provider shall respond with a Plan of Correction pursuant toSection 132.45(a). The Plan of Correction shall address all of thedeficiencies listed on the Notice of Deficiencies. The Plan of Correctionmust identify the actions that have been, or will be, taken to comply withthis Part and the timeframes for implementing the corrective actions.Unless otherwise specified, the timeframes for implementing correctiveactions must follow the requirements specified in Section 132.45. Theprovider must submit this Plan of Correction to the Certifying StateAgency within 30 days after the return receipt of the Notice ofDeficiencies.A)Providers that submit a Plan of Correction approved by theCertifying State Agency shall be notified of the approval. TheCertifying State Agency shall notify the provider of the approvalwithin 30 days after the Certifying State Agency receives theprovider's Plan of Correction. The Certifying State Agency shallverify the provider's implementation of the Plan of Correction atthe next review. If a Plan of Correction was required, the nextreview shall occur within 12 months after the date the Plan ofCorrection was approved.i)If the findings at the next review indicate that a providerhas failed to implement a Plan of Correction, the Certifying

DHS59 ILLINOIS ADMINISTRATIVE CODE 132132.30State Agency may revoke the provider's certification.ii)Compliance reviews for recertification shall be conductedon or about the expiration date of the current certificationperiod.B)If a provider submits a Plan of Correction that does not address thedeficiencies noted during a review pursuant to subsection (g)(4),the Certifying State Ag

132.30 Application, Certification and Recertification Processes 132.35 Recertification and Reviews (Repealed) 132.40 Certification for Additional Medicaid Community Mental Health Services and/or New Site(s) (Repealed) 132.42 Post-Payment Review 132.44 Appeal of Post-Payment Review Findings 132.45 Compliance with Certification Requirements