Section 500.60  Provider Qualifications/Credentialing and Enrollment

 

a)         Credentialing and enrollment, as set forth in this Part, is only for the purpose of providing and being reimbursed for EI services as set forth in this Part. It is not a license.

 

b)         An individual shall meet the pertinent licensing, degree, education and/or certification requirements for the service to be provided, as set forth in Appendix C, as well as the requirements set forth in this Section, in order to qualify for and maintain a credential to provide EI services.  Credentialed providers must also enroll in order to be reimbursed for services.

 

c)         To be credentialed and maintain the credential the individual shall also:

 

1)         not be delinquent in paying a child support order as specified in Section 10-65 of the Illinois Administrative Procedure Act [5 ILCS 100/10-65];

 

2)         not be in default of an educational loan in accordance with Section 3 of the Education Loan Default Act [5 ILCS 385/3];

 

3)         not have served or completed a sentence for a conviction of any of the felonies set forth in Section 25(a) and (b) of the Health Care Worker Background Check Act [225 ILCS 46] within the preceding five years (see Section 50-10 of the Illinois Procurement Code [30 ILCS 500]);

 

4)         not have been determined to be a perpetrator of an indicated incident of child abuse or neglect in an investigation by Illinois under the Abused and Neglected Child Reporting Act [325 ILCS 5] or by another state under that state's laws for at least the previous five years;

 

5)         be in compliance with pertinent laws, rules, and government directives regarding the delivery of services for which they seek credentialing.

 

d)         Applicants for a credential shall consent to a background check as set forth in 89 Ill. Adm. Code 385.30(c) through the Illinois Department of Children and Family Services, consisting of review of CANTS/SACWIS, Illinois Sex Offender Registry and criminal history.

 

e)         Temporary Credential

An individual who is not currently credentialed and has submitted an application to the Department's credentialing office, including an acceptable plan for ongoing professional development as required in subsection (k)(2), and has met the  pertinent requirements provided in Appendix C, as well as documentation of completion of EI systems training as defined in subsection (f)  and other requirements in this Part, will be issued a temporary credential and may provide EI services.

 

f)         EI Systems Training

 

1)         In order to qualify for a credential, an individual must document the completion of EI systems training as required and provided by the Department.  Parent Liaisons and Service Coordinators must complete this training within 90 days after the receipt of the temporary credential for such service.  This training shall include at least:

 

A)        Practice and procedures of private insurance;

 

B)        The role of the regional intake entities, service coordination, program eligibility determinations, family fees, All Kids, and the Division of Specialized Care for Children (DSCC) applications, referrals and coordination with EI, and procedural safeguards;

 

C)        Introduction to the EI Program, including provider enrollment and credentialing, overview of EI Program policies and regulations, and billing requirements; and

 

D)        Evaluation and assessment of birth-to-three children, individualized family service plan development, monitoring and review, EI philosophy and best practices, and quality assurance.

 

2)         A temporary credential may be issued to  a Parent Liaison or Service Coordinator, who shall document completion of training as required and approved by the Department, within 90 days after the receipt of the temporary credential for such service.  This training shall include at least the EI systems training, set forth in subsections (f)(1)(A) through (D), as well as:

 

A)        Use of the management information system;

 

B)        Regional intake entity operating philosophies and procedures; and

 

C)        Transition.

Extensions of up to 90 days may be granted upon written request setting forth facts concerning noncompliance with this requirement. The Department's credentialing office will consider extreme hardship and other extenuating circumstances and determine if an extension should be granted on an individual basis.

 

g)         Education

 

1)         Individuals who hold a credential on July 1, 2007, other than individuals who hold a professional license in the State of Illinois, as set forth in Appendix C, as part of the first subsequent credential renewal application process, must provide documentation of the completion of educational experiences, as approved by the Department, that include at least two semester college hours or the equivalent (30 clock hours or continuing education unit (CEU) credit hours) in each of the following EI core knowledge content areas.  Parent Liaisons are not required to provide this documentation.

 

A)        The Development of Young Children:  Typical and Atypical;

 

B)        Working with Families of Young Children with Disabilities;

 

C)        Intervention Strategies for Young Children with Special Needs; and

 

D)        Assessment of Young Children with Special Needs.

 

2)         To qualify for a temporary credential, developmental therapists must document completion of educational experiences, as approved by the Department, that include at least two semester college hours or the equivalent (30 clock hours or CEU credit hours) in each of the EI core knowledge content areas listed in subsection (g)(1).  As of July 1, 2007, all other applicants for a temporary credential, other than individuals that hold a professional license in the State of Illinois, as set forth in Appendix C, shall document completion of these educational experiences within 18 months after issuance of a temporary credential.  Extensions of up to six months may be allowed upon request in writing, received at least 30 days before the expiration of the credential, setting forth the facts concerning noncompliance with this requirement.  The Department's credentialing office will consider hardship and other extenuating circumstances and determine if an extension should be granted on an individual basis.

 

h)         Consultation Requirement Either Prior to or During Temporary Credential

 

1)         In order to qualify for full credential, an individual must complete and document consultation while providing 240 hours of direct services, for which they are being credentialed, to children ages birth to three with special needs and their families, except that Developmental Therapists/Vision, Orientation and Mobility Developmental Therapists, Developmental Therapists/Hearing, and providers credentialed under the EI service categories of Clinical Assessment, Counseling and other Therapeutic Services, Nursing, Nutrition and Social Services, as defined in Appendix C, need only document 120 hours.   Documentation must show that the individual participated in consultation with an appropriately experienced individual of the same discipline/EI service group who has experience working with children ages birth to three with special needs and their families.  The consultation shall be in compliance with the professional standards of the individual seeking the credential, as determined and documented by the consultant.

 

2)         Individuals who do not meet the consultation requirement in subsection (h)(1) shall complete and document such experience within 18 months after issuance of their temporary credential.  Extensions of up to six months may be granted upon written request, received at least 30 days before the expiration of the credential, setting forth the facts concerning noncompliance with this requirement.  The Department's credentialing office will consider extreme hardship and other extenuating circumstances and determine if an extension should be granted on an individual basis.

 

i)          Full Credential

Once an individual with a temporary credential has documented satisfactory completion of the requirements in subsections (g) and (h), as well as the ongoing professional development requirement in subsection (k)(2), he/she is eligible to be fully credentialed.

 

j)          Evaluation and Assessment Services

             Evaluation and assessment services for the purpose of determining initial eligibility, participating in the development of an initial comprehensive IFSP, and adding new types of services to existing IFSPs must be provided by a provider with a credential for Evaluation/Assessment as set forth in Appendix C in addition to an EI Specialist credential in the discipline required by the service being evaluated.

 

k)         Renewal of Credential

Full credentials are valid for three years.  60 to 90 days before his/her credential expires, a provider shall submit a renewal application to the Department in a form required by the Department.  To qualify for renewal, the provider must have met and provide documentation of the following continuing professional education and development activities, as well as documentation of maintenance of pertinent licensure/certification requirements and compliance with this Part.  Failure to receive a renewal notice from the Department shall not excuse the submission of a renewal application for one's credential.

 

1)         Continuing Professional Education

During the three years that the full credential is valid, a credentialed provider shall receive a total of 30 hours of continuing professional education as approved by the Department.  Up to 20 of those hours shall be provided by the Department, or its training designee.  The provider credential notification and renewal letters will define the number of hours that shall be provided by the Department or its training designee.  The remaining training hours shall include one or more of the EI core knowledge content areas set forth in subsections (g)(1)(A) through (D).  Extensions of up to three months may be granted upon written request, received at least 30 days before the expiration of the credential, setting forth the facts concerning noncompliance with this subsection (k)(1).  The Department's credentialing office will consider extreme hardship and other extenuating circumstances and determine if an extension should be granted on an individual basis.  The extension shall not extend the time within which the subsequent year's training requirements must be received.

 

2)         Ongoing Professional Development

 

A)        A credentialed provider (including temporary) shall participate in a system of ongoing professional development that  includes a once a month non-billable meeting held either face-to-face or over the telephone with either an individual specialist-level credentialed provider or a group, of which at least one member is a specialist-level credentialed provider in order to facilitate best practices through case review.  Each provider shall submit an ongoing professional development plan with his/her initial and renewal credential application in a format provided by the Department, and shall also report ongoing professional development activities when moving from temporary to a full credential status and upon credential renewal to the Department's credentialing office or upon request of the Department or its designee in a format provided by the Department.  Documentation of ongoing professional development must demonstrate that a credentialed provider participated in ongoing professional development meetings in at least 75 percent of the months in his/her temporary or full credential period.

 

B)        Service Coordinators and Parent Liaisons employed by regional intake entities shall participate in ongoing professional development experience as defined and implemented through a contractual agreement between the Department and the regional intake entity, instead of the requirement of this subsection (k)(2).

 

l)          Restoration of Lapsed Credential

A credential that has lapsed for one year or less may be restored upon application proving the receipt of 30 hours of continuing professional education, as continuing professional education is defined in subsection (k)(1), and documentation of ongoing professional development as defined in subsection (k)(2).

 

m)        Enrollment

Credentialed providers (including temporary) must enroll with the Department in order to bill and receive payment for EI services.  Enrollment requires the payee entity to enter into a Service Provider Agreement  with the Department that establishes the duties, expectations, and relationships between the Department and the Individual Provider or the Provider Agency.  Providers shall submit an enrollment application packet at the same time they submit an application for a credential.  Providers credentialed as an "associate", as defined in Appendix C, are not required to enroll, but shall be supervised by a specialist who is credentialed and enrolled in the same discipline, as set forth in Appendix D.  The payee entity will bill for the services provided by the associate level provider under the name of the associate's supervisor.  The payee entity, supervisor and associate will comply with all directives and policy and procedural changes.  Failure to receive Department payments, directives and policy and procedural changes, due to failure to comply with this subsection, shall not excuse compliance with those directives and changes.

 

n)         Change of Name or Address

Credentialed providers shall notify the Department's credentialing office of any change of name or address within 30 days prior to billing under the new name and/or address, or 30 days after such change, whichever comes first.  Correct information is  required for a provider to receive payment for services.

 

o)         Providers shall also enroll with HFS to become an All Kids provider, simultaneously with EI enrollment.

 

p)         An individual applying for or renewing enrollment shall state whether he or she is also enrolled as a DSCC provider.

 

q)         Termination of Credential/Enrollment

 

1)         Credentialing/enrollment, as set forth in this Section, is not a license. Rights of credential and enrollment are set forth in the Service Provider Agreement.  In addition to the provisions of this subsection (q), the Department may exercise any rights it has under the Service Provider Agreement to terminate the agreement.

 

2)         The following shall result in immediate automatic termination of a provider's credential and enrollment:

 

A)        Failure to comply with the requirements of subsection (g) and/or (h) within the time period or within a Department-granted extension not exceeding the maximum extension time allowed.

 

B)        Failure to successfully enroll in, exclusion from or termination from participation in All Kids and/or other programs of federal or State agencies.

 

C)        Lapse of credential/enrollment  for over 1 year without complying with subsection (l) or failure to bill for services for more than 12 consecutive months.

 

D)        Suspension or termination of the license and/or certification required for the service for which one is credentialed.

 

E)        Failure to meet or maintain other credential and enrollment requirements set forth in this Section.

 

3)         The following shall also result in termination of a provider's credential and enrollment:

 

A)        Failure to comply with provisions of this Part, or with EI Service Provider Agreements, or with other laws and regulations relevant to the services for which there is a credential.

 

B)        Unprofessional conduct.

 

C)        Complaints the Department has determined are founded and significant.

 

D)        Professional performance not consonant with recognized standard of care or adverse action of a professional society or other professional organization.

 

E)        Lack of timely cooperation regarding the submission of and adequacy of reports, the development of appropriate goals and objectives and the development of  multidisciplinary treatment plans.

 

F)         Inappropriate billing practices.

 

4)         The provider shall be notified of the date of termination and the reason, and shall help to transition clients to new providers.  The provider may request an informal hearing, but the request shall not affect the termination date, which may proceed prior to the informal hearing.  The request must be made within 30 days after the notice of the termination.

 

5)         The provider may present relevant information, witnesses and evidence to the Secretary or his/her designee, in person or in writing.  The Secretary or the designee will review the information presented and any supplemental investigation performed by the Department and issue a decision within 30 days after the hearing.

 

6)         The decision of the Secretary or the designee shall be final.

 

r)          The Department may deny an application for credential and enrollment or a Service Provider Agreement if the applicant's past conduct resulted in the termination of his or her credential and enrollment or Service Provider Agreement.  An applicant may appeal a denial for a credential and enrollment or Service Provider Agreement based on a prior termination pursuant to subsection (q).

 

(Source:  Amended at 38 Ill. Reg. 11086, effective May 12, 2014)