Section 240.1120  Participant Transfer Request – Provider to Provider – With Change in Service

a)         A request for transfer of a CCP participant from one provider to another provider within the same service area that requires a change in the services provided shall be completed by the CCU following a redetermination of need.  The request may be initiated by the Department, CCU, the vendor, or the participant/authorized representative verbally or in writing to the CCU.  The CCU shall complete the redetermination of need, including obtaining a completed and signed Participant Agreement and Consent Form – Person-Centered Plan of Care from the participant/authorized representative, within 30 calendar days after the date of the request unless delayed by the participant/authorized representative.

b)         Reasons for a provider to provider transfer with a required change in service may include:

1)         a change in the participant's condition; and

2)         the provider's inability to meet the service needs of the participant, as required by the person-centered plan of care.

c)         The CCU shall:

1)         no later than 15 calendar days after the date of redetermination, complete in accordance with Section 240.945 and forward:

A)        the Participant Agreement − Person-Centered Plan of Care to the participant/authorized representative;

B)        a copy of the Participant Agreement − Person-Centered Plan of Care, the CCP Participant Agreement to the receiving provider on the same day the Participant Agreement − Person-Centered Plan of Care is sent to the participant/authorized representative;

C)        a copy of the Participant Agreement − Person-Centered Plan of Care to the transferring provider.

2)         Upon receipt of the provider's signature on the Participant Agreement – Person-centered Plan of Care, a copy of the executed Participant Agreement – Person-centered Plan of Care shall be placed in CCU's participant file and a copy shall be forwarded to the participant/authorized representative.

d)         The effective date of transfer shall be no later than 15 calendar days after the date of the Participant Agreement − Person-Centered Plan of Care and service shall be initiated by the receiving provider without service interruption.

e)         If any delay in any of the time frames established in this Section is caused by the documented action or inaction of the participant/authorized representative, time frames shall be extended by the number of calendar days of delay.

(Source:  Amended at 48 Ill. Reg. 11053, effective July 16, 2024)