The CSP organization should work with their designated Certifying State Agency (CSA) to complete the steps for voluntarily withdrawing a provisionally or fully certified CSP servicing location.
The DHS-DMH Provider Access, Credentialing, and Enrollment Unit (PACE) and the DHS-Bureau of Accreditation, Licensure and Certification (BALC) shall assist with completion of the requirements if the Illinois Department of Human Services (DHS) is the designated CSA. The Infant Parent Institute (IPI) shall assist with completion of the requirements if the Illinois Department of Children and Family Services (DCFS) is the designated CSA.
The following are the steps that a CSP servicing location must take to voluntarily withdraw a Provisional or Full Certificate for a CSP site (i.e., close a site).
1. CSP Notifies CSA of Voluntary Withdrawal
Written notification must be submitted to the designated CSA, DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov or DCFS-IPI at DCFS.Medicaid@illinois.gov, when the organization is wanting to voluntarily withdraw certification. The notification should be received thirty calendar (30) days before site closure and include the:
- Employer Identification Number (EIN)/Tax Identification Number (TIN) of the CSP
- Address of the site
- Effective date of withdrawal
- Reason for withdrawal
- Primary contact name and title
- Primary contact email address and telephone number
2. Notice of Voluntary Withdrawal Issued
If DHS is the designated CSA, DHS-DMH-PACE shall notify DHS-BALC of the voluntary withdrawal of certification by forwarding a copy of the notification received.
The designated CSA, DHS-BALC or DCFS-IPI, shall issue a "Notice of Voluntary Withdrawal of Certification" to the organization within thirty (30) calendar days of receipt of the CSPs notification. The designated CSA shall also forward a copy of the notice to DHS-DMH-PACE.
3. Bureau of Community Programs Notified (applies DHS is the designated CSA)
When DHS is the designated CSA, DHS-DMH-PACE shall notify the respective Program Manager of the voluntary withdrawal of certification by forwarding a copy of the CSPs notification and Form 2.
Other:
- A CSP organization that has voluntarily withdrawn their certification may reapply for certification at any time in accordance with Rule 132 standards.
