FAQ CCP Provider Qualification Requirements

The business plan and audited financial report should show how the specific service for which certification is being sought relates to information about the entire applicant agency. This information should coincide with the strategic plan of the applicant agency. Although the relevant topics to be included are determined by the business for itself, typical information would include a formal listing of business goals for the future, the reasons why the goals are necessary and attainable, and the plans for reaching the goals. This information will be used by the Department to help understand the overall business prospects of the applicant agency.

Yes. There are templates available from a variety of sources to help develop a cover sheet; table of contents; executive summary; description of the business, its market and competition; available products, technology, and/or services, including current usage, growth, marketing, and risks; financial data; and management expertise in terms of strengths, weaknesses, and/or opportunities; and other information unique to the business.

One possible resource is the U.S. Small Business Administration. Other helpful information about doing business with the State of Illinois may be found at Sell to Illinois.

The audited financial report should be prepared by an independent Certified Public Accountant.

Section 240.1520(n) of the CCP rules states: "Providers shall provide the Department with an annual audit report to be completed by an independent Certified Public Accountant and in accordance with 74 Illinois Administrative Code 420, Subpart D. The audit report shall be filed at the office of the Illinois Department on Aging, 421 East Capitol Avenue, #100, Springfield, Illinois 62701-1789, within 6 months from the date of the close of the provider's business fiscal year."

The Department requires assets sufficient to cover 90 days of CCP operating expenses as a reasonable business precaution to ensure continuity in the delivery of service in the case of payment delays. A provider agency must be able to continue in business, meeting all rule requirements, between the time CCP services are initially provided and the time reimbursement is received from the Illinois Comptroller. It could potentially take 90 calendar days or more for a payment cycle depending on fund availability in the State Treasury. Understanding the payment cycle is a matter of particular importance to new provider agencies that, for an initial period, will have no State reimbursement to cover required expenditures.

The Department recommends that the agency base the amount needed on its business plan and past experiences with the State of Illinois or other units of government.

No. CCP provider agencies for in-home services that operate exclusively under this program are exempt from the licensing requirement imposed upon home service agencies under the Home Health, Home Services, and Home Nursing Agency Licensing Act [see 210 ILCS 55]. If an agency only intends to provide CCP service, it must only meet certification requirements set by the Department. However, most home service agencies will also provide services to non-CCP clients in which case a license must also be obtained from the Illinois Department of Public Health.

Yes. Other factors which may influence the certification decision include: pending or current Departmental contract action for failure to adhere to Provider Agreement requirements, including a history of non-compliance; notification by another governmental entity of similar contract actions or non-compliance; legal notification of financial insolvency, criminal indictment or conviction, or other legal issues which, in the opinion of the Department, would make the award of a contract contrary to the best interests of the state; or a contract award is not in the best interests of the program. For more information regarding administrative requirements for certification, refer to the CCP rules, Section 240.1505(a)(7).

A CCP geographic area varies by region:

•     other than in Cook County, the geographic area will be the county;
•     in Cook County outside the city of Chicago, the geographic area will be the township; and
•     within the city of Chicago, the geographic area will be sub-areas, defined by Zip Codes set forth in Section 240.1505(a)(1)(C) of the CCP rules.

The goal of the Department is for a certified provider agency to serve an entire CCP geographic area, if possible.

Adjustment of the geographic service area might be permitted to assure that:

• no geographic area remains unserved;
• entities serving limited- or non-English-speaking clients are not excluded from participation as service providers in CCP;
• providers that are, or are controlled by, a unit of local government and cannot operate outside the jurisdiction of that local government are not excluded from participation as service providers in CCP (e.g., a city health department);
• regional benevolent, charitable, social or religious organizations that have as their charter providing services to a specific population or geographic area smaller than a county, township of CCP sub-area are not excluded from participation as CCP service providers (e.g., a community action agency or hospital); and
• transportation to/from adult day service facilities can be completed in a reasonable period of time.

Adjustment will be allowed in only limited circumstances. It is not intended for routine use that might lead to "cherry-picking" or make it more difficult to address needs in hard to serve areas in a cost-effective manner.

A discretionary adjustment of the geographic service area requirement would only be made if the applicant agency meets one of the specified exceptions set forth in Section 240.1505(a)(2) of the CCP rules. If not, then the Department will expect the applicant agency to serve an entire CCP geographic service area in order to be certified under the program.

No.

Yes.

Section 240.1505(a)(6) of the CCP rules requires the following service-related experience for the different types of provider agencies:

• For prospective In-Home Service provider agencies: A minimum of 3 years experience in business operations providing in-home service, one of which must be in Illinois.
• For prospective Adult Day Service provider agencies: A minimum of 2 years experience in business operations providing adult day service.

The Department may adjust these requirements on an individual applicant basis.

Actual service experience is useful in predicting the ability to meet the various certification standards for the CCP. Also, it is in the best interests of clients and CCP to certify provider agencies with ongoing business operations to minimize disruption of service continuity and to maximize the delivery of services by certified providers throughout the entire State of Illinois as soon as possible.

There is no specific time limit in Section 240.1505(a)(6) of the CCP rules. However, experience that is not current will not be useful in predicting the ability to meet the various certification standards for CCP.

Inclusion of a service adjustment for experience is intended to establish a fair protocol for exceptions, but permitting exceptions remains a matter of discretion and reflects a balancing effort on the part of the Department to encourage small business development. The Department recognizes need to review other indicators for success, especially since situations arise with some frequency where there is an organization change in private business. Service adjustments for experience are not intended to become the norm under CCP.

The Department believes that the following services will be comparable to CCP services:

1. Home health agencies licensed by the Illinois Department of Public Health. The Illinois Department of Public Health defines Home Health Services as services provided to a person at the residence according to a plan of treatment for illness or infirmity prescribed by a physician or podiatrist. Such services include part-time and intermittent nursing services and other therapeutic services such as physical therapy, occupational therapy, speech therapy, medical social services or services provided by a home health aide.

2. Service provider agencies under contract with other state agencies, such as the Illinois Department of Human Services (Office of Rehabilitation Services), Illinois Department of Veterans Affairs, etc.

3. Private pay service provider agencies, including those funded as a personal insurance benefit, providing services comparable to CCP services. For more information about the pertinent points of comparison for this service, refer to the CCP rules, Sections 240.210 and 240.230.

4. Hospitals or Nursing Homes providing adult day services comparable to CCP adult day services. For more information about the pertinent points of comparison for this service, refer to the CCP rules, Section 240.230.

Each request for adjustment of the experience requirement will be determined on its own merits and factual circumstances. As stated in Section 240.1505(a)(6)(B)(ii) of the CCP rules, the Department allows adjustments only when it is in the best interests of CCP and when the health, safety and welfare of CCP clients and the quality of services provided will not be adversely affected.

The following are examples of situations in which the Department might allow an adjustment to the experience requirement:

• An applicant wishes to provide in-home service to a recent group of political refugees in the Chicago area. There is no other provider agency in the geographic area where the refugees reside which understands the language and the culture. The applicant is also a recent refugee, has only been in the United States for a few years and does not have the required experience. However, the applicant is being assisted by the relevant CCP provider association, Coalition for Limited-English Speaking Elderly (CLESE), local government, local landlords and/or others in the development of the business.

• An applicant wishes to establish an adult day service site in an area where no adult day service is available. The applicant is a hospital which has adequate funding and adequate space for the site. Qualified personnel are available in the community and through the hospital. The applicant has no experience in providing adult day service, but is able to hire an experienced adult day service coordinator/director both as a consultant to develop the site and to oversee the daily operation of the site.

• A sole proprietor retires and sells the business to a long-time employee. The focus is on experience at daily operations staff level. However, the Department must be informed immediately of any staff changes involving staff members upon whom the adjustment was based, including the agency plan for replacing that staff member.

Specific job descriptions should be included for all positions that provide service to CCP clients.