Each servicing location functioning as a CMHC, within an organization, must be certified and have an approved enrollment within the IMPACT (Illinois Medicaid Program Advanced Cloud Technology) System prior to billing for Medicaid services and receiving reimbursement. Certification is achieved by the organization demonstrating compliance with Rule 132 standards.
If 50% or more of the funding source for community mental health treatment, for the CMHC organization as a whole, is from the Illinois Department of Human Services (DHS)-Division of Mental Health (DMH) or if the funding source from both DHS-DMH and the Illinois Department of Children and Family Services (DCFS) are considered equal, DHS serves as the designated Certifying State Agency (CSA). If more than 50% of the funding source for community mental health treatment, for the CMHC organization as a whole, is from DCFS, DCFS serves as the designated CSA. Questions regarding who serves as the designated CSA may be forwarded to DHS-DMH Provider Access, Credentialing, and Enrollment Unit (PACE) at DHS.DMHProviderAssist@illinois.gov DCFS-IPI at DCFS.Medicaid@illinois.gov.
The organization should work with their designated CSA, DHS or DCFS, to add a CMHC servicing location to their current Provisional or Full Certificate. DHS-DMH-PACE and the DHS-Bureau of Accreditation, Licensure and Certification (BALC) shall assist with completion of the requirements if DHS is the designated CSA. The Infant Parent Institute (IPI) shall assist with completion of the requirements if DCFS is the designated CSA.
The following are the steps that a provisionally or fully certified CMHC organization must take to add a servicing location.
1. Obtain a Type 2 NPI (National Provider Identifier) Number from the National Plan and Provider Enumerator System (NPPES)
Each servicing location that an organization wants added to a Provisional or Full Certificate, and which is operating under the organizations single Employer Identification Number (EIN)/Tax Identification Number (TIN), must have a separate and distinct Type 2 NPI number assigned by NPPES to be able to individually enroll the added site in the IMPACT System per the HFS Community-Based Behavioral Services Provider Handbook-Section 202.7. The NPI number for each added site must be associated with the Taxonomy Code of 261QM0801X (Community Mental Health) and/or 320800000X (Community Based Residential Treatment Facility, Mental Illness). Refer to the NPPES registry to obtain a separate and distinct Type 2 NPI number for each individual site.
2. Enroll Site in IMPACT
If access to the IMPACT System has not been established by the user, refer to the Illinois Department of Healthcare and Family Services (HFS) PowerPoint Presentation below for instructions on how to create a new IMPACT account and gain entry.
Presentations and Materials | HFS (illinois.gov)
Each added site shall need to be enrolled individually in IMPACT. The IMPACT "Business Process Wizard" (BPW) application screen shall outline the IMPACT steps to be completed. Some steps are required, and some steps are optional, with this being indicated on the BPW.
Points for enrolling a CMHC site in IMPACT:
- Select the IMPACT Enrollment Type of "Facility/Agency/Organization".
- For Step 2, the Locations Step, make sure to go back in and add a Correspondence Address. The application cannot be completed without it.
- In Step 3, the Specialties/Taxonomy Step,
- First, select "Outpatient" and/or "Residential Services" in the Add Specialties step. The specialties of "Crisis Response", "Day Treatment", "Team Based Services", and any of their associated subspecialties, should not be selected. These specialties/subspecialties may be selected, and additional steps taken with HFS to provide these services, after the site has been provisionally certified.
- Second, enter the taxonomy code associated with the NPI number as listed with NPPES on the Taxonomy Details step. For a site providing outpatient mental health services on a non-institutional basis, the taxonomy code listed should be 261QM0801X. For a site providing community residential mental health services, the taxonomy code listed should be 320800000X. Both taxonomy codes may be entered on this step if both taxonomy codes are associated with the Type 2 NPI number with NPPES.
- In the Add License/Certificate/Other step, select "DHS State License" or "DCFS State License", on the License/Certification/Other List step based upon the designated CSA. In the drop down provided, a pseudo license number of CMHC99999 should be listed with an effective date of the date in which the IMPACT application shall be submitted to HFS and an end date of 12/31/2999. The information on this step shall be updated by the State once a Provisional Certificate has been issued.
- For the ownership step, one managing employee and one board member will need to be listed. The SSN, DOB, and Home Address are required for each. The 501c3 will also need to be listed.
- At a minimum, answer "Yes" to the following question on the Complete Enrollment Checklist step:
- Do you carry professional liability insurance? If yes, please provide the name of your carrier and the policy coverage limit per occurrence and in aggregate.
- The name of the professional liability carrier as well as the occurrence and the aggregate must be entered in the corresponding "Comments" box (example: Philadelphia 1M/3M).
During the enrollment process, an "Application ID" number shall be received. This number should be retained for future reference.
Once an IMPACT application is completed for a site, the application should be submitted to HFS. The following link accesses the IMPACT System: https://impact.illinois.gov
If questions or needing assistance with the IMPACT application process, contact the designated CSA or the IMPACT Help Desk:
If experiencing difficulties in logging into the IMPACT System, contact:
The IMPACT System serves as the SYSTEM OF RECORD for the receipt of Federal Medicaid funding, therefore, all CMHC organizations are responsible for maintaining their enrollment(s) with up-to-date and accurate information at all times.
3. CMHC Notifies CSA of Site Addition
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 wanting to add a servicing location. The notification should include the:
- Employer Identification Number (EIN)/Tax Identification Number (TIN) of the CMHC organization
- NPI Associated with the site
- Address of the added servicing location
- IMPACT Application ID number for the added servicing location
- Primary contact name and title
- Primary contact email address and telephone number
- Attestation that the policies and procedures in effect at the added servicing location are in compliance with Rule 132 standards for a CMHC.
- Whether or not a State Fire Marshal inspection has been conducted at the added servicing location (an added servicing location must satisfactorily pass an inspection prior to being approved for provisional certification)
- If a State Fire Marshal inspection has not been conducted at the added servicing location, the Fire Inspection Request Form needs to be completed and submitted with the notification (form obtained by contacting the designated CSA, DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov or DCFS-IPI at DCFS.Medicaid@illinois.gov )
- If a State Fire Marshal inspection has been conducted at the added servicing location within the last two (2) years and passed, a copy of the inspection report must be submitted
If questions regarding the notification or Fire Inspection Request Form, contact the designated CSA at the email address above.
The designated CSA shall review the notification and any associated documents and, if complete, the certification process shall continue. If the notification or any of the associated documents are incomplete or missing, the designated CSA shall reach out to the organization to address any problem identified.
When DHS serves as the designated CSA, DHS-DMH-PACE shall forward the notification and any associated documents to DHS-BALC after reviewed and approved.
4. Fire Clearance Scheduled
The designated CSA, DHS-BALC or DCFS-IPI, shall request the scheduling of a fire clearance inspection with the Office of the State Fire Marshal if the site has not been inspected within the last two (2) years and the inspection passed.
The designated CSA has no influence over the scheduling of State Fire Marshal inspections.
The designated CSA is not able to answer questions related to fire clearance requirements. If questions regarding fire clearance requirements, contact the Office of the State Fire Marshal at SFMtechservices@illinois.gov.
5. Site visit scheduled
Site visit will be scheduled by the designated CSA per Federal Regulations, due to CMHC classification as moderate risk providers. When DHS serves as the designated CSA, DMH will coordinate the scheduling of the onsite visit. When DCFS serves as the designated CSA, IPI will coordinate the scheduling of the onsite visit. Provider shall ensure the physical environment is conducive to the provision of behavioral health services by being safe, functional, sanitary, and comfortable prior to scheduling the site visit.
6. Provisional Certificate Issued
A Provisional Certificate shall be issued by the designated CSA, DHS-BALC or DCFS-IPI, for the added site upon receipt of documentation evidencing that the site has successfully passed the Office of the State Fire Marshal fire clearance requirements and DMH/IPI site visit.
The Provisional certificate shall allow for the operation of the added CMHC site effective with the date indicated on the certificate and shall be in effect for twelve (12) months, unless modified by the CSA. The designated CSA shall forward the Provisional Certification to the organization via email.
If DHS is the designated CSA, DHS-BALC shall also forward a copy of the Provisional Certificate to DHS-DMH-PACE.
7. IMPACT Application Processed
The designated CSA, DHS-DMH-PACE or DCFS-IPI, shall notify HFS Provider Enrollment (PE) Unit of the added servicing location having met Rule 132 requirements thus the IMPACT application being ready for review and approval. A copy of the Provisional Certificate shall be forwarded by the designated CSA to the HFS PE Unit with the notification.
The HFS PE Unit shall review and approve the IMPACT application if no issues are identified. Once approved, a systematically generated email from the IMPACT System shall be received by the organization signifying the approval. If the HFS PE Unit is unable to approve the IMPACT application for any reason, such as due to a background screening result, the Unit shall notify the designated CSA, DHS-DMH-PACE or DCFS-IPI, so further steps may be discussed and action taken.
8. Illinois Mental Health Collaborative Notified of Provisional Certification
The designated CSA, DHS-DMH-PACE or DCFS-IPI, shall notify the CMHC organization to complete:
Form 1 and Form 2 serve to notify the Administrative Service Organization (ASO), the Illinois Mental Health Collaborative (Carelon), of data that is necessary for Federal reporting requirements.
Forms 1 and 2 are located on the DHS Rule 132 website or may be obtained by the organization contacting the designated CSA at the email address above. Please see Instructions for Completing Form 1 and 2 for details on completing and submitting the forms.
The completed Form 1, if applicable, and Form 2 should be forwarded to the designated CSA, DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov or DCFS-IPI at DCFS.Medicaid@illinois.gov. If DCFS-IPI is the designated CSA, DCFS-IPI shall forward Form 1 and Form 2 to DHS-DMH-PACE. DHS-DMH-PACE shall forward the completed form(s) to the Illinois Mental Health Collaborative. A copy of the Provisional Certificate shall also be forwarded to the Collaborative.
9. Bureau of Community Programs Notified (applies when DHS is the designated CSA)
When DHS is the designated CSA, DHS-DMH-PACE shall notify the respective Program Manager of the new provisionally certified CMHC site by forwarding Form 1, if applicable, Form 2, and a copy of the Provisional Certificate. Program Manager, upon receipt of the Provisional Certificate, shall reach out to the added CMHC site to ensure that the site is becoming operational within the twelve (12) month provisional time frame.
10. Site Inspection by the CSA (DHS-BALC or DCFS-IPI)
The designated CSA, DHS-BALC or DCFS-IPI, shall conduct a site inspection within the twelve (12) month provisional certification period and when the site is operational, unless modified by the CSA. The inspection shall include the added site and sister sites. The number of sister sites inspected for the organization shall be at the discretion of the CSA.
- If found to be in compliance, the designated CSA shall notify the CMHC within thirty (30) calendar days after the site review and a Full Certificate issued.
- If found to not be in compliance, the designated CSA shall issue the CMHC a Notice of Violation within fifteen (15) calendar days after the site review. The organization shall
- respond to the notice by the due date indicated, by submitting a Plan of Correction, or be subject to loss of certification. The due date for the CMHC responding shall be approximately thirty (30) calendar days from the date of the notice.
- If the Plan of Correction submitted is found to satisfactorily address all identified violations, the designated CSA shall notify the CMHC within thirty (30) calendar days of the change in certification status from provisional to full certification and a Full Certificate issued.
- If no Plan of Correction is received or if the Plan of Correction submitted is found to not satisfactorily address all the identified violations, the designated CSA shall notify the organization within thirty (30) calendar days of its failure to retain certification and the right to appeal pursuant to Rule 132 Section 132.110 Appeal of Certification Determination. If the designated CSA is DHS, DHS-BALC shall also notify DHS-DMH-PACE of the failure to retain certification who shall in turn notify respective Program Manager. Additional notifications shall occur as follows:
- DHS-DMH-PACE or DCFS-IPI shall notify HFS-PE Unit
- DHS-DMH-PACE or DCFS-IPI shall notify the Illinois Mental Health Collaborative
If questions regarding the site inspection, contact the designated CSA, DHS-BALC at DHS.Rule132BALC@illinois.gov or DCFS-IPI at DCFS.Medicaid@illinois.gov.
A site failing to fully operationalize within the twelve (12) month provisional time frame shall result in a meeting being convened by designated CSA Staff. If DHS is the designated CSA, this shall include DHS-DMH-PACE, DHS-BALC and respective Program Manager. The reason(s) for the site's failure to become operational shall be outlined at the meeting. Based upon the information presented, a final determination shall be made by the designated CSA if the CMHC site will or will not be granted an extension to their Provisional Certificate expiration date.
- If a decision is made to extend the Provisional Certificate expiration date, a Continuation letter shall be issued by the designated CSA, DHS-BALC or DCFS-IPI, to the CMHC. If DHS is the designated CSA, DHS-BALC shall also forward a copy of the Continuation letter to DHS-DMH-PACE.
- DHS-DMH-PACE or DCFS-IPI shall update the IMPACT System to reflect the new expiration date for the Provisional Certificate and approve the modification. If DHS is the designated CSA, DHS-DMH-PACE shall forward a copy of the Continuation letter to the respective Program Manager.
- If a decision is made by the designated CSA to not extend the Provisional Certificate expiration date, the designated CSA, DHS-DMH-PACE or DCFS-IPI, shall notify HFS-PE Unit of the need to change the site's Business Status in IMPACT to "In-Active/Closed" and notify the Illinois Mental Health Collaborative.
11. Full Certificate Issued
If found to be in compliance with Rule 132 standards at the site visit as outlined in Step 9, a Full Certificate shall be issued by the designated CSA, DHS-BALC or DCFS-IPI, which shall remain in effect for three (3) years, unless modified by the CSA. The designated CSA shall forward the Full Certificate to the organization via email.
If DHS is the designated CSA, DHS-BALC shall also forward a copy of the Full Certificate to DHS-DMH-PACE.
12. IMPACT System Updated
Once the provider receives the full certificate, the provider shall modify/update the sites License/Certification/Other List step in the IMPACT System by changing the certificate end date to reflect that which is now in effect. The HFS PE Unit shall review and approve the IMPACT application if no issues are identified. Once approved, a systematically generated email from the IMPACT System shall be received by the organization signifying the modification being completed and approved.
13. Bureau of Community Programs Notified of Full Certification (applies only when DHS is the designated CSA)
When DHS is the designated CSA, DHS-DMH-PACE shall forward a copy of the Full Certificate to the respective Program Manager.
Other:
- Professionally Licensed Employees rendering services to consumers at an added newly certified CMHC site are encouraged to enroll in the IMPACT System with an Enrollment Type of "Individual/Sole Proprietor - Regular Individual/Sole Proprietor or Rendering/Servicing Provider" and associate themselves to the new site. If the employee is already enrolled in the IMPACT system, the employee should modify their current IMPACT enrollment to reflect the association with the new site.
- An association of an individual to a CMHC site is accomplished by completing the Associate Billing Provider/Other Associations step in the employee's individual IMPACT application/enrollment.
- The newly certified CMHC site may elect to become a participating provider in HFS contracted Managed Care Organization plans. To become an in-network provider for a plan, the organization shall need to reach out to the specific MCO. For further information, refer to:
- HFS Managed Care Programs website which includes MCO contact information: Illinois' Managed Care Programs | HFS
- HFS Care Coordination website which includes MCO contact information and the HFS Managed Care Manual for Medicaid Providers: Care Coordination | HFS(Illinois.gov)
- An organization that wants to withdraw from the certification process at any time should notify the designated CSA, DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov or DCFS-IPI at DCFS.Medicaid@illinois.gov.
