Licensed Practical Nurse or Registered Nurse, Home-Based (HBS)

Nursing Services are in addition to any Medicaid State Plan nursing services for which the individual qualifies.  The need for these services must be documented in the individual's service plan.  Nursing Services must be within the scope of the Illinois Nursing and Advanced Practice Nursing Act (225 ILSC 65).  Nursing Services are only available to individuals in the Adult DD Waiver who are authorized for Home-Based Support Services (HBS).

How do I enroll as a Developmental Disabilities Medicaid Waiver Provider?

  1. Obtain a National Provider Identifier from the National Plan and Provider Enumeration System. 
    1. The NPI must be a Type 1- Individual.
    2. The taxonomy code should align with your credentials and services that you be providing. 
  2. Send a copy of your approval letter to:  DHS.DDDMedProv@illinois.gov .
  3. Create an IMPACT account on the IMPACT login page.  Please use the Single Sign-On ID PowerPoint Presentation found on the IMPACT Presentations and Materials page on the HFS website to complete this step. 
  4. When the Single Sign-On ID has been approved, return to the IMPACT login page and log into your account.  On the IMPACT home page there will be a blue IMPACT hyperlink located under the 4 green boxes.  Click on the IMPACT hyperlink.
  5. Click on NEW ENROLLMENT. 
    1. On the next screen, select the Enrollment Type: 
      • Individual/Sole Proprietor
      • Regular Individual/Sole Proprietor or Rendering/Servicing Provider
    2. On the Basic Information page, select the applicant type Rendering/Servicing Only. 
    3. Please use the Individual Sole Proprietor PowerPoint Presentation found on the IMPACT Presentations and Materials page to complete the application as a Rendering/Servicing Only applicant type. step. IMPACT application must includes the following information:
      1. Associate Provider:
        1. DDD Billing Provide ID number 7094718
        2. Employer's NPI or IMPACT Provider ID.
      2. Associate MCO Plan: DDD MCO Plan ID number 3000006.
  6. Send an email to DHS.DDDMedProv@illinois.gov to notify DHS, Division of Developmental Disabilities that your application has been submitted for state review
  7. Complete a Payee Designation/Authorization form (IL462-1180) to authorize the company that you are working for to submit the billing and receive the payment for the services you provide.
  8. You will receive an email notification from the IMPACT system when your provider enrollment application has been approved.  You may begin providing services at that time. 

Important Resources for Program Requirements