The CMHC organization should work with their designated Certifying State Agency (CSA) to complete the steps for voluntarily closing a CMHC servicing location.
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 or DCFS-IPI at DCFS.Medicaid@illinois.gov.
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.
If the CMHC site is relocating, see workflow for Relocation of a CMHC Site. If the CMHC organization is closing all certified sites, see workflow for Voluntary Withdrawal of a CMHC Certificate.
The following are the steps that a CMHC organization must take to voluntarily close a certified site with the organization still having other operational servicing locations.
1. Illinois Medicaid Program Advanced Cloud Technology (IMPACT) System Modified
The IMPACT enrollment for the closing certified CMHC site must be modified by completing the Complete Modification Checklist step and submitting the modification to the Illinois Department of Healthcare and Family Services (HFS) for review and approval. The enrollment shall be modified by answering "Yes", at a minimum, to the question "Do you wish to end date your enrollment?" on the checklist. The effective date of site closure must be indicated in the corresponding "Comments" box.
The following link accesses the IMPACT System: https://impact.illinois.gov
If questions or needing assistance with IMPACT, 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.
2. CMHC Notifies CSA of Voluntary Site Closure
Written notification of the voluntary site closure must be submitted to the designated CSA, DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov or DCFS-IPI at DCFS.Medicaid@illinois.gov. The notification should be received within thirty (30) calendar days of site closure and include the:
- Employer Identification Number (EIN)/Tax Identification Number (TIN) of the CMHC organization
- Address of the closing site
- NPI number of the closing site
- Effective date of site closure
- Reason for site closure
- Primary contact name and title
- Primary contact email address and telephone number
- A statement if the site closure will or will not affect the ability to meet the standards detailed in Rule 132 for the CMHC organization
- Form 1 (Change to DHS/DMH Provider Record - Administration Information) if there have been any administrative changes within the organization since the last Form 1 was completed or if Form 1 has never been completed for the organization.
- Form 2 (Request for Change to DHS/DMH Provider Record - Site Location Information), top portion of page one (1) only, for the closing site.
Forms 1 and 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. If questions regarding the notification or forms, contact the designated CSA at the email address above.
If DCFS-IPI is the designated CSA, DCFS-IPI shall forward Form 1 and Form 2 to DHS-DMH-PACE.
3. Updated Certificate Issued
If DHS is the designated CSA, DHS-DMH-PACE shall notify DHS-BALC of the voluntary site closure by forwarding a copy of the notification received.
The designated CSA, DHS-BALC or DCFS-IPI, shall issue an updated certificate to the organization via email within (30) calendar days of receipt of the notification. The designated CSA shall also forward a copy of the updated certificate to DHS-DMH-PACE.
4. IMPACT Modification Processed
The designated CSA, DHS-DMH-PACE or DCFS-IPI, shall notify HFS-Provider Enrollment (PE) Unit of the voluntary site closure by forwarding a copy of the notification. For the closing site's IMPACT enrollment, HFS-PE shall change the Business Status from "Active" to "In-Active/Closed" with an effective date as listed in the notification.
5. 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 voluntary site closure by forwarding a copy of the notification, Form 1, if applicable, and Form 2.
6. Illinois Mental Health Collaborative Notified
DHS-DMH-PACE shall notify the Illinois Mental Health Collaborative of the voluntary site closure by forwarding Form 1, if applicable, and Form 2.
Other:
- An organization that has voluntarily closed a CMHC site may reapply for certification at any time in accordance with Rule 132 standards.
- Professionally Licensed Employees enrolled in the IMPACT System, and who had associated themselves to the closed CMHC site, should end date their association with the site.
- A disassociation of an individual with a CMHC site is accomplished by completing the Associate Billing Provider/Other Associations step and the Complete Modification Checklist step in the employee's individual IMPACT enrollment and submitting the modifications to HFS for review and approval.
- The organization should notify all associated in-network HFS contracted MCO plans of the CMHC site closure.
