Section 2070.60 Provider Qualifications/Credentialing and Enrollment

TITLE 23: EDUCATION AND CULTURAL RESOURCES

SUBTITLE A: EDUCATION

CHAPTER XI: DEPARTMENT OF EARLY CHILDHOOD

PART 2070 EARLY INTERVENTION PROGRAM

SECTION 2070.60 PROVIDER QUALIFICATIONS/CREDENTIALING AND ENROLLMENT

Section 2070.60  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

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

sued 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

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

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

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

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

ation

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)

st 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

s 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

tment-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

lients 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).