The CMHC organization should work with their designated Certifying State Agency (CSA) to complete the steps for adding on to an existing CMHC 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 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.
This workflow is to be used when adding a floor, suite, or apartment under the same roof (i.e.- 123 Main St, Floor 1 is certified; adding Floor 2). This can also be used if construction has been done to add space at an existing location. A new NPI and IMPACT application is not necessary in this case unless the agency wants to have them certified and enrolled separately. If that is the case, please refer to the Adding a CMHC Site Workflow.
The following are the steps that a provisionally or fully certified CMHC organization must take to add on to an existing CMHC certification.
1. CMHC Notifies CSA of the Addition to the Existing Site
Written notification of the addition to the current site add must be submitted to the designated CSA DHS-DMH-PACE at DHS.DMHProviderAssist@illinois.gov or DCFS-IPI atDCFS.Medicaid@illinois.gov. The notification should include the:
- Employer Identification Number (EIN)/Tax Identification Number (TIN) of the CMHC
- NPI of Existing Enrollment
- Address of Current Servicing Location
- Area that is being added (Suites, floors, etc.….)
- Primary contact name and title
- Primary contact email address and telephone number
- Attestation that the policies and procedures in effect 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.
2. DHS-BALC Notified of the Addition (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 State Fire Marshal via the contact us section Office of the State Fire Marshal website.
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.
6. 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.
7. 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.
