The CMHC organization should work with their designated Certifying State Agency (CSA) to complete the steps for a shift in primary funding source.
If the Illinois Department of Human Services (DHS) is the designated CSA, the DHS-Division of Mental Health (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 Children and Family Services (DCFS) is the designated CSA, the Infant Parent Institute (IPI) shall assist with completion of the requirements.
The following are the steps that a CMHC organization must take if there is a shift in primary funding source for community mental health treatment. The shift in primary funding source would apply to the CMHC organization as a whole and would entail the primary funding source transferring from DHS to DCFS or from DCFS to DHS.
1. CMHC Notifies Originating CSA of Shift in Primary Funding Source
Steps 1 and 3 may be completed concurrently.
Written notification must be submitted by the CMHC organization to the originating CSA of the shift in primary funding source. If the originating CSA is DHS, the written notification should be forwarded to DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov. If the originating CSA is DCFS, the written notification should be forwarded to DCFS-IPI at DCFS.Medicaid@illinois.gov. The notification shall include the:
- CMHC name on file with the originating CSA
- Employer Identification Number (EIN)/Tax Identification Number (TIN) of the CMHC
- Listing of all CMHC sites operating under the EIN/TIN along with each site's Type 2 NPI number
- Primary contact name and title
- Primary contact email address and telephone number
- Current W-9
- 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 the organization has never been registered with the Illinois Mental Health Collaborative.
- Form 2 (Request for Change to DHS/DMH Provider Record - Site Location Information) if there have been any changes since the last Form 2 was completed for each site or if any of the sites have never been registered with the Illinois Mental Health Collaborative.
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.
Form 1 and Form 2 are located on the DHS Rule 132 website or may be obtained by 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 completion of any of the required forms, contact the originating CSA at the email address above.
2. Originating CSA Forwards Information
If DHS is the originating CSA, the notification received by DHS-DMH-PACE shall be forwarded to DHS-BALC. DHS-BALC shall then forward the following documents to the new CSA, DCFS-IPI:
- Notification
- Current certificate
- Last site survey results
- Office of the State Fire Marshal (OSFM) inspection reports for each site
If DCFS is the originating CSA, DCFS-IPI shall then forward the following documents to the new CSA, DHS-BALC and DHS-DMH-PACE:
- Form 1 and Form 2s (if applicable)
- Notification
- Current certificate
- Last site survey results
- Office of the State Fire Marshal (OSFM) inspection reports for each site
If a site is missing a current OSFM inspection, within the last two (2) years, the transfer will be held until the originating CSA has received current inspection reports for all sites. Fire clearance must be obtained prior to proceeding with the transfer.
The receiving CSA shall reach out to the originating CSA if any further information is needed.
The receiving CSA shall reach out to the CMHC organization if any additional information is needed or if any forms need completed.
3. IMPACT Modified
Each site's enrollment in the IMPACT System must be modified by selecting and completing the following step on the "Business Process Wizard" (BPW) application screen:
- New CSA Certificate Number will be added to enrollment.
- Old CSA Certificate will be end dated.
- Other modifications may be made to an enrollment at this time, such as updating contact information or email addresses, changing a managing employee, or changing a correspondence address.
The modified enrollment(s) should be submitted to HFS after completed.
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 IMPACT enrollment(s) with up-to-date and accurate information at all times.
4. IMPACT Modifications Processed
The originating CSA, DHS-DMH-PACE or DCFS-IPI, shall notify HFS-PE Unit of the CMHC organization having had a shift in primary funding source and that each site's IMPACT modifications are ready for review and approval. A copy of the CMHC's notification referencing the shift in funding source shall be forwarded to HFS-PE Unit.
HFS-PE Unit shall review and approve the IMPACT modifications for each enrollment if no issues are identified. The organization shall receive an IMPACT System generated email signifying the approvals. If the HFS-PE Unit is unable to approve any enrollment with IMPACT modifications, such as due to a background screening result, the Unit shall notify the originating CSA, DHS-DMH-PACE or DCFS-IPI, so further steps may be discussed, and action taken.
5. Certification End Date Extension (if applicable)
If the CMHCs Provisional or Full Certificate is to expire in the next six (6) months from the transfer from one CSA to another, the originating CSA, DHS-BALC or DCFS-IPI, shall extend the certificate expiration date for three (3) months from the certificate end date to allow for the new CSA to review the documents received from the originating CSA and schedule the CMHC for a site review. In this instance, the originating CSA shall:
- Update the current certificate to reflect the extension in expiration (if the originating CSA is DHS, this shall be completed by DHS-BALC)
- Forward the updated certificate as follows:
- If the originating CSA is DCFS, the updated certificate shall be forwarded to the CMHC, DHS-DMH-PACE and DHS-BALC.
- If the originating CSA is DHS, the updated certificate shall be forwarded to the CMHC, DHS-DMH-PACE and DCFS-IPI at DCFS.Medicaid@illinois.gov.
- Update the License/Certification/Other List step in IMPACT for each enrollment to reflect the extended certificate end date and approve the modification (if the originating CSA is DHS, this shall be completed by DHS-DMH-PACE)
6. 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 shift in primary funding source by forwarding the notification received from the CMHC, a copy of the current certificate, and if applicable, any Form 1 and 2s received.
7. Illinois Mental Health Collaborative Notified
DHS-DMH-PACE shall forward any Form 1 and 2s received to the Illinois Mental Health Collaborative.