Section 140.1001  Registration Conditions for Alternate Payees

a)         In order to participate, alternate payees must meet the following conditions:

1)         Hold a valid, appropriate license when State law requires licensure of medical practitioners, agencies, institutions and other medical entities;

2)         Be certified for participation in the Title XVIII Medicare program when federal or State rules and regulations require certification for Title XIX participation;

3)         Be certified for Title XIX when federal or State rules and regulations so require;

4)         Qualify as:

A)        Hospital or a hospital affiliate as defined by the Hospital Licensing Act  [210 ILCS 85];

B)        Professional school that offers a degree to qualify individuals for licensure to perform medical services;

C)        Group practice solely owned by three or more full-time licensed individual practitioners who are eligible to participate in the Medical Assistance Program;

D)        Partnership that requires fees of its partners to be turned over to the partnership and all partners are eligible to participate in the Medical Assistance Program;

E)        Individual practitioner "employer" who requires an employee, as a condition of employment, to turn over his or her fees to the employer.  The employer must be eligible to participate in the Medical Assistance Program.  An employer who qualifies as a payee for more than four practitioners, and an employer who is not licensed in the same profession as the practitioners in his or her employ who have designated the employer as the alternate payee, shall be subject to enhanced screening and verification by the Inspector General of the Department, except when an advanced practice nurse licensed under the Nurse Practice Act [225 ILCS 65] designates an employer who is a physician licensed under the Medical Practice Act of 1987 [225 ILCS 60];

F)         Corporation registered with the Illinois Secretary of State's Office to do business in the State of Illinois.  A corporation registered with the Illinois Secretary of State's Office to do business in the State of Illinois, whose shares of ownership are not publicly traded in a recognized stock exchange within the United States of America, shall be subject to enhanced screening and verification by the Inspector General of the Department;

G)        Governmental entity that requires, as a condition of employment, that the fees be turned over to the governmental entity;

H)        Community mental health agency that is certified by the Department of Human Services under 59 Ill. Adm. Code 132 and is enrolled as a provider in the Medical Assistance Program; or

I)         Federally Qualified Health Center, Rural Health Center or Encounter Rate Clinic that is enrolled as a provider in the Medical Assistance Program;

5)         Provide registration information to the Department, in the prescribed format;

6)         Notify the Department, in writing, immediately whenever there is a change in any information that the alternate payee has previously submitted;

7)         Provide disclosure, as requested by the Department, of all financial, beneficial, ownership, equity, surety, or other interests in any and all firms, corporations, partnerships, associations, business enterprises, joint ventures, agencies, institutions, or other legal entities providing any form of health care services to public assistance recipients and alternate payee relationships; and

8)         Have a current alternate payee registration on file with the Department.

b)         Approval of a corporate entity such as a group practice, a partnership, hospital, or professional school as an alternate payee in the Medical Assistance Program applies only to the entity's existing ownership, corporate structure, and location.  Therefore, an alternate payee's registration in the Medical Assistance Program is not transferable.

c)         For purposes of administrative efficiency, the Department may periodically require classes of alternate payees to re-register in the Medical Assistance Program.  Under the re-registration, the Department shall request classes of alternate payees to submit updated information.  Failure of an alternate payee to submit updated information within the requested time frames may result in cancellation of the alternate payee registration from the Program.  The cancellation shall have no effect on the future eligibility of the alternate payee to participate in the Program and is intended only for purposes of the Department's efficient administration of the Program. 

d)         For purposes of this Section, an alternate payee whose alternate payee investor ownership has changed by 50 percent or more from the date the alternate payee was initially approved for registration as an alternate payee in the Medical Assistance Program shall be required to submit a new application for registration. All applications must meet the requirements for registration.

(Source:  Amended at 36 Ill. Reg. 15361, effective October 15, 2012)