Section 686.920  Provider Staffing Requirements, Qualifications, and Training

a)         Each case management agency shall designate an individual who will be responsible for the administration of the case management program.  The designated individual shall have or be actively enrolled in a program to obtain:

1)         a bachelor's degree in health, human services, or a related field;

2)         licensure as a registered nurse pursuant to the Nurse Practice Act [225 ILCS 65]; or

3)         at least one year of experience as a home health care administrator, medical clinic administrator, or other health services administrator.

b)         The qualifications for case managers shall be as follows:

1)         A registered nurse, with a current license and a bachelor's degree in nursing, social work, social sciences, or counseling or one year of case management experience; or

2)         A social worker with a bachelor's degree in either social work, social sciences, or counseling.  A Bachelor of Social Work or a Master of Social Work degree from a school accredited by any organization nationally recognized for the accreditation of schools of social work is preferred; or

3)         An individual with a Bachelor's Degree in a human services field (including, but not limited to, sociology, special education, or rehabilitation counseling) and with a minimum of one year of case management experience.

c)         In addition, it is mandatory that the case manager has:

1)         a broad knowledge of community resources and networking, case management, and home care; and

2)         experience in working with racial and ethnic minorities, as well as one or more of the following:

A)        domestic abuse;

B)        the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community;

C)        persons living with HIV/AIDS; or

D)        persons with substance use disorders.

d)         Each full-time case manager shall have no more than 30 fee-for-service customers and 70 Managed Care Organization (MCO) customers, or an appropriately weighted combination of fee-for-service customers and MCO customers that shall not exceed 100 total customers.  For half-time case managers, the full-time requirements may be met proportionately (e.g., 15 fee-for-service customers and 35 MCO customers and shall not exceed 50 total customers).

e)         Annually, each case manager shall undergo a minimum of 12 hours of in-service training that shall be:

1)         furnished by the case management agency; and

2)         relevant to the provision of services to persons with HIV/AIDS (e.g., infectious disease control procedures, sensitivity training, and updates on information relating to treatment procedures).

(Source:  Amended at 47 Ill. Reg. 19328, effective December 13, 2023)