Relocation of a Community Mental Health Center (CMHC) Servicing Location

The CMHC organization should work with their designated Certifying State Agency (CSA) to complete the steps for relocating 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.

The following are the steps that a provisionally or fully certified CMHC organization must take to relocate a servicing location. Services may not be provided at the relocated site, and be reimbursed, until the site has been certified in accordance with Rule 132 standards. This certification includes the relocated site having a State Fire Marshal inspection completed and passed.

1. CMHC Notifies CSA of Site Relocation

Written notification of the CMHC site relocation 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 include the:

Employer Identification Number (EIN)/Tax Identification Number (TIN) of the CMHC
Address of the current servicing location
Address of the new servicing location
NPI of enrollment relocating
Primary contact name and title
Primary contact email address and telephone number
Attestation that the policies and procedures in effect at the new servicing location shall be in compliance with Rule 132 standards for a CMHC
Whether or not a State Fire Marshal inspection has been conducted at the relocated site (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 relocated site, 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 relocated site within the last two (2) years and passed, a copy of the inspection report must be submitted

If questions regarding the notification or completion of the Fire Inspection Request Form, contact the designated CSA at the email address above.

2. DHS-BALC Notified of Site Relocation (applies only when DHS is the designated CSA)

When DHS is the designated CSA, DHS-DMH-PACE shall review the notification and associated documents and, if complete, forward the notification and the Fire Inspection Request Form or State Fire Marshal inspection report to DHS-BALC.

3. 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.

4. 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.

5. Provisional Certificate Issued

A Provisional Certificate shall be issued by the designated CSA, DHS-BALC or DCFS-IPI, to the CMHC organization for the relocated 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 relocated 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 Certificate 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.

6. Illinois Medicaid Program Advanced Cloud Technology (IMPACT) Modified

The IMPACT enrollment for the site that is relocating must be modified to reflect the new address at which services shall be rendered. This is accomplished by completing the Locations step and the Complete Modification Checklist step in IMPACT. Other modifications to the enrollment may be made at this time, such as updating contact information or email addresses, changing a managing employee, or changing a correspondence address. Once all modifications have been made, the modified enrollment should be submitted to the Illinois Department of Human Services (HFS).

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:

DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov
DCFS-IPI at DCFS.Medicaid@illinois.gov
IMPACT Help Desk at IMPACT.Help@illinois.gov or 877-782-5565 - Option: 1, 2 & 1

If experiencing difficulties in logging into the IMPACT System, contact:

IMPACT.Login@illinois.gov and/or DoIT.Okta.Support@illinois.gov

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.

7. IMPACT Modifications Processed

The designated CSA, DHS-DMH-PACE or DCFS-IPI, shall notify HFS-Provider Enrollment (PE) Unit that the IMPACT modifications for the relocated site are ready for review and approval. A copy of the Provisional Certificate, listing the relocated site, shall be forwarded to HFS-PE Unit with the notification.

HFS-PE Unit shall review and approve the IMPACT modifications 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 HFS-PE Unit is unable to approve the IMPACT modifications 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 Site Relocation

The designated CSA, DHS-DMH PACE or DCFS-IPI, shall notify the CMHC organization to complete:

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 a Form 1 has never been completed for the organization.
Form 2 (Request for Change to DHS/DMH Provider Record - Site Location Information) for the relocating site as well as for any site that is currently certified though no Form 2 ever completed. For Form 2, page one (1) only needs to be completed for the relocating site if none of the other information on the form has changed. The entire form must be completed if never submitted for a 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.

The form(s), once completed, should be returned 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-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 CMHC site relocation 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 relocated 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 relocated site and, if there are any sister sites, may include these sites as well. The number of 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 the 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, 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

When the organization is found to be in compliance with Rule 132 standards at the site visit as outlined in Step 10, a Full Certificate shall be issued by the 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 (applies 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:

The CMHC organization shall need to reach out to any HFS contracted MCO plan, in which they are an in-network provider, regarding the site relocation.