Specialty Telehealth and Assessment Team (STAT) Service Provider Application and Process

Specialty Telehealth and Assessment Team (STAT) Service Provider Application and Process

Thank you for your interest in becoming a STAT provider. Please review the qualifications and requirements before completing the application below. You will submit it for review and approval to IDHS-Division of Developmental Disabilities Clinical Team at DHS.ClinicalServices@illinois.gov. Providers can begin providing the service when they receive an IDHS-DDD letter of approval in addition to successfully completing all IMPACT enrollment requirements. To learn more about the STAT service, you can read this DRAFT Information Bulletin: Specialty Telehealth and Assessment Team (STAT) Information Bulletin.

STAT Provider Qualifications:

Below are the requirements that interested providers must meet to be approved as a STAT provider.

This service must be provided or overseen by physicians who are:

  • Licensed to practice medicine in Illinois, or have appropriate reciprocity; and
  • Board Certified or board eligible with the American Board of Medical Specialties (ABMS).

Functions which are overseen by a physician with the above qualifications will be provided by a Registered Nurse, Certified Registered Nurse Practitioner, or Physician's Assistant acting within their scope of practice.

Per the Adults with Developmental Disabilities Waiver, agencies must meet the following standards regardless of provider service location:

  1. Have a waiver service location in the United States.
  2. Become a DDD approved IMPACT provider and sign Attachment A to comply with all applicable federal and state statutes, regulations, and policies, including but not limited to confidentiality and HIPAA requirements. Providers are required to develop and implement written privacy policies and procedures that are consistent with privacy requirements. DDD reviews these policies and procedures when complaints are received regarding privacy or as part of licensing or QA&I when warranted.
  3. Complete training on Rule 50 specific mandatory abuse and neglect reporting.
  4. Have Commercial General Liability Insurance.
  5. Have Workers' Compensation Insurance in accordance with state law.
  6. Have a minimum of five years' experience in serving individuals with intellectual and developmental disabilities in their own homes, family homes, licensed residential homes, Intermediate Care Facilities (ICFs), or other types of long-term supports and services.
  7. Ensure compliance with Telehealth Platform Requirements that include the specifics of state file acceptance, HIPAA requirements, access timelines and secure communication to customers, families and other caregivers, and providers will be outlined and binding in provider contracts and manuals.
  8. Ensure compliance with Telehealth Platform Training Requirements, which include timely, accessible initial and ongoing training for customers, family/caregivers and providers; help line capacity and ongoing health education modules, with for those working with customers enrolled with the provider to increase health care knowledge will be specific and binding in provider manuals and contracts.
  9. Provide continuing education in the area of intellectual and developmental disabilities to the provider's physician network.
  10. Submit to DDD or its designee successful results from a self-assessment validating staff qualifications, required documentation, policies and procedures every 3 years.
  11. Have a comprehensive quality review program and provide a report via secure e-mail of aggregated findings quarterly, as well as annually, to the Division of Developmental Disabilities, which must include, at a minimum, the following:
    1. Data analysis.
    2. Service outcomes such as reductions in Emergency Room visits and inpatient stays. Additional information may be requested by DDD.
    3. Customer, family and/or caregivers of customers, and provider satisfaction
    4. Complaints and resolution.
  12. Have a participant support call center that is staffed 24 hours a day, 7 days a week.
  13. Have publicly posted references related to the provider's business history and practices.
  14. Provide educational training sessions to the provider's clinical staff on topics relevant to the physical and behavioral health care needs of individuals with intellectual and developmental disabilities at least monthly.

All staff who will render this service must have completed specialized training/curriculum on how to provide medical assessment, treatment interventions, and recommendations regarding the physical health care needs of individuals with intellectual disabilities, developmental disabilities or autism.

Physicians providing this service must have access to and be familiar with clinical guidelines for the provision of health care to individuals with intellectual and developmental disabilities. Clinical guidelines must be based on evidence-based practices and clinical expertise and serve to inform the health care decisions and recommendations.

STAT Provider Application:

Please answer all the questions below. Once completed, please submit this application to DHS.ClinicalServices@illinois.gov. Providers can begin providing the service when they receive an IDHS-DDD letter of approval.

  1. Contact:
  2. Organization:
  3. Email:
  4. Phone:
  5. Please confirm that your organization has become an IMPACT provider to comply with all applicable federal and state statutes, regulations, and policies, including but not limited to confidentiality and HIPAA requirements.
  • Yes, I have included supporting documentation.
  • No

6. Please confirm that the service will be provided or overseen by physicians who are:

  1. Licensed to practice medicine in Illinois, or have appropriate reciprocity; and
  2. Board Certified or board eligible with the American Board of Medical Specialties (ABMS).
    • Yes, I have included supporting documentation (such as evidence of current licensure.
    • No

7. Provision of service will be overseen by a physician and provided by either a Physician, Registered Nurse, Certified Registered Nurse Practitioner, or Physician's Assistant acting within their scope of practice.

  • Yes, I have included supporting documentation.
  • No

Agencies must meet the following standards regardless of provider service location:

8. Have a waiver service location in the United States.

  • Yes, I have included supporting documentation.
  • No

9. Confirm that you have developed and implement written privacy policies and procedures that are consistent with privacy requirements. DDD reviews these policies and procedures when complaints are received regarding privacy or as part of licensing or QA&I when warranted.

  • Yes, I have included supporting documentation.
  • No

10. Confirm Commercial General Liability Insurance.

  • Yes, I have included supporting documentation.
  • No

11. Confirm Workers' Compensation Insurance in accordance with state law.

  • Yes, I have included supporting documentation.
  • No

12. Confirm a minimum of five years' experience in serving individuals with intellectual and developmental disabilities in their own homes, family homes, licensed residential homes, Intermediate Care Facilities (ICFs), or other types of long-term supports and services.

  • Yes, I have included supporting documentation.
  • No

13. Confirm that you have a participant support call center that is staffed 24 hours a day, 7 days a week.

  • Yes, I have included supporting documentation.
  • No

14. Confirm educational training sessions to the provider's clinical staff on topics relevant to the physical and behavioral health care needs of individuals with intellectual and developmental disabilities have occurred.

  • Yes, I have included supporting documentation.
  • No

15. Confirm all staff who will render this service have completed specialized training/curriculum on how to provide medical assessment, treatment interventions, and recommendations regarding the physical health care needs of individuals with intellectual disabilities, developmental disabilities or autism.

  • Yes, I have included supporting documentation.
  • No

16. Please outline your organization's ability to implement this service. You can provide experience in other states or experience working with individuals with I/DD, include data, and consumer service survey findings were appropriate.

Once this application has been completed. Please email the application and supporting documentation to DHS.ClinicalServices@illinois.gov. You will be notified through email about your application.

NEXT STEPS

If your application is accepted, please note there are additional items, your organization will be responsible for completing including the following:

  1. Training on Rule 50 specific mandatory abuse and neglect reporting should be completed by staff.
  2. Have a comprehensive quality review program and provide a report via secure e-mail of aggregated findings quarterly, as well as one time annually, to the Division of Developmental Disabilities, which must include, at a minimum, the following:
    1. Data analysis.
    2. Service outcomes such as reductions in Emergency Room visits and inpatient stays. Additional information may be requested by DDD.
    3. Customer, family and/or caregivers of customers, and provider satisfaction.
    4. Complaints and resolution.
  3. Have publicly posted references related to the provider's business history and practices.
  4. Have demonstrated evidence of positive outcomes for customers which includes at a minimum:
    1. Reductions in Emergency Room visits and inpatient stays; and 
    2. Caregiver and individual satisfaction with the service. 
    3. Ensure compliance with Telehealth Platform Requirements that include the specifics of state file acceptance, HIPAA requirements, access timelines and secure communication to customers, families and other caregivers, and providers will be outlined and binding in provider contracts and manuals.
  5. Ensure compliance with Telehealth Platform Training Requirements, which include timely, accessible initial and ongoing training for customers, family/caregivers and providers; help line capacity and ongoing health education modules, with for those working with customers enrolled with the provider to increase health care knowledge will be specific and binding in provider manuals and contracts.
  6. Provide continuing education in the area of intellectual and developmental disabilities to the provider's physician network.
  7. Submit to DDD or its designee successful results from a self-assessment validating staff qualifications, required documentation, policies and procedures every 3 years.

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