Becoming a Medicaid Certified Community Mental Health Provider
Interested organizations that are not currently certified to provide Rule 132 services per 59 Ill. Adm. Code 132, must submit the following information to the Division of Mental Health as a pre-qualification for certification to be a Medicaid Community Mental Health provider.
- Organization name, FEIN, Authorized Agency Representative Name and Any Relevant Title (including license(s), Organization Address, Email Address and Telephone Number
- Statement from the Illinois Secretary of State's office that the organization is currently in good standing to do business in the State of Illinois
- Report of an Illinois State Police fingerprint-based background check on the organization's authorized agency representative done within the previous 30 calendar days
- Printout from the Illinois Department of Public Health's Healthcare Worker Registry on the organization's authorized agency representative printed within the previous 10 calendar days
- References from other organizations, funders, etc. including contact names and phone numbers
- Report from the Illinois Department of Financial and Professional Regulation that the organization's authorized agency representative, if a licensed professional in Illinois, is in good standing regarding his/her license
- Description of what the organization does or plans to do that meets needs identified in the area in which they plan to provide Rule 132 services
- Description of specialized services they intend to make available including evidence-based services or services for specialized populations such as forensics or child and adolescent services
- Evidence of national accreditation of mental health services or plan to obtain national accreditation in mental health services
- Description of programs currently funded by other state agencies or divisions of DHS along with a state contact person and phone number
Providers that are currently certified to provide Rule 132 services per 59 Ill. Adm. Code 132 by the Illinois Department of Children and Family Services or are certified by the DHS Division of Alcohol and Substance Abuse to provide Rule 2090 services per 77 Ill. Adm. Code 2090 must submit the only following information to the Division of Mental Health as a pre-qualification for certification to be a Medicaid Community Mental Health provider funded by DMH.
- Provider name, FEIN, Authorized Agency Representative Name and Any Relevant Title (including license(s), Provider Address, Email Address and Telephone Number
- References from other organizations/providers, funders, etc. including contact names and phone numbers
- Description of what the organization does or plans to do that meets needs identified in the area in which they plan to provide Rule 132 services
- Description of specialized services they intend to make available including evidence-based services or services for specialized populations such as forensics or child and adolescent services
- Description of programs currently funded by other state agencies or divisions of DHS along with a state contact person and phone number
All documents must be submitted to:
Illinois Department of Human Services
Division of Mental Health
600 E. Ash St., Bldg. 500, 3rd Flr.
Springfield, IL 62703-3273
Review of documents will begin when all have been received at the above address. For more information, contact DHS.DMHProviderAssist@illinois.gov.
