State Recognition Details | Joint Commission
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Thursday 3:43 CST, January 18, 2018

State Recognition Details

State Recognition Contact Directory


The Joint Commission actively monitors state legislative and regulatory activities for the purpose of identifying additional opportunities for state reliance on Joint Commission accreditation/certification.

The Joint Commission’s various accreditation/certification programs are recognized and relied on by many states in the states’ quality oversight activities. Recognition and reliance refers to the acceptance of, requirement for, or other reference to the use of Joint Commission accreditation, in whole or in part, by one or more governmental agencies in exercising regulatory authority. Recognition and reliance may include use of accreditation for licensing, certification or contracting purposes by various state agencies. 
 

STATE: PROGRAM:


State: Illinois
Program: Home Care
Agency: Department of Aging
State Reference: 89 IL ADC 240.1505
Setting/Service: In-Home Services
Type of Recognition: Licensure

B) The Department reserves the right to:

i) adjust the experience requirements specified in subsection (a)(5)(A) if the provider agency submits proof of current accreditation or certification by an appropriate national organization for the service for which Department certification is being requested. For in-home services, the following national accreditation organizations are acceptable:

Accreditation Commission for Health Care (2005, no later amendments or editions included), 4700 Falls of Neuse Rd., Suite 280, Raleigh NC 27609;

Community Health Accreditation Program (2004, no later amendments or editions included), 1300 19th St., Suite 150, Washington DC 20036;

The Joint Commission (2009, no later amendments or editions included), One Renaissance Blvd., Oakbrook Terrace IL 60181.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Alcoholism and Substance Abuse
State Reference: 77 IL ADC 2090.50  and 77 IL ADC 2060.315
Setting/Service: Sub-acute Alcoholism and Substance Abuse Treatment Programs
Type of Recognition: Licensure

Each provider shall have and adhere to a quality improvement plan developed in compliance with the provisions in 77 Ill. Adm. Code 2060.315. i) All treatment and intervention licensees shall develop and maintain a written policy and procedures manual that describes the operation of the organization. At a minimum, the manual shall explain how the organization will comply with all federal and State regulatory and contractual requirements, any additional requirements from independent accrediting bodies, and any other organizational policies and procedures. The manual shall be approved by the board of directors of the organization or, if not applicable, the organization representative and annually reviewed and revised as necessary. The manual shall be submitted to the Department at the time of licensure and upon request from Department staff. The manual shall also be reviewed during the first year of employment by all staff. Annually thereafter, the organization shall ensure that all staff shall review updated sections pertinent to such staff.

State: Illinois
Program: Behavioral Health Care
Agency: Department of Children and Family Services
State Reference: 89 IL ADC 411.45 
Setting/Service: Secure Child Care Facility
Type of Recognition: Licensure

a) Upon request, the Department shall issue an application for a license to operate a secure child care facility to a qualified applicant, as defined in this Part. The application for license or the renewal of a license shall be completed and signed by the governing body of the facility or its authorized representatives on forms prescribed and furnished by the Department.

b) The application shall include the following:

1) Documentation of accreditation by one or more of the following nationally recognized accrediting organizations:

B) The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181. Documentation of current accreditation status shall be achieved by submission by the secure child care facility to the Department of a certificate of accreditation and the most recent accreditation report, and a letter from the accrediting organization (see definition of “Qualified Applicant”), dated within 30 days prior to the date of the application for licensure, stating that the secure child care facility is in good standing with the organization.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Children and Family Services
State Reference: 59 IL ADC 135.10
Setting/Service: Residential Treatment Facilities
Type of Recognition: Licensure

“Licensed private facilities.” Residential treatment facilities licensed by the Department of Children and Family Services (DCFS) in accordance with DCFS rules at 89 Ill. Adm. Code 404, Licensing Standards for Child Care Institutions and Maternity Centers, or, for out-of-state facilities, in accordance with Section 15.1 of the Mental Health and Developmental Disabilities Administrative Act [20 ILCS 1705/15.1], which have been accredited by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) as a psychiatric facility serving children and adolescents or which have been surveyed and approved by the Department as meeting standards equivalent to standards for psychiatric facilities serving children and adolescents found in the 1997 Standards for Behavioral Health Care (the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181 (1996)).

State: Illinois
Program: Ambulatory Health Care
Agency: Department of Healthcare and Family Services
State Reference: 89 IL ADC 140.438 
Setting/Service: Imaging Centers
Type of Recognition: Medical Assistance Program

Participation Requirements for Imaging Centers To participate in the Illinois Medical Assistance program, an imaging center must, in addition to any other Department requirements, be licensed or certified:

A) for participation in the Medicare program; or
B) by the Joint Commission on Accreditation of Health Care Organizations (JCAHO); or
C) by a local or public health department; or
D) by any government agency having jurisdiction over the services provided and/or the equipment being used.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Healthcare and Family Services
State Reference: 89 IL ADC 148.40
Setting/Service: Inpatient Psychiatric Treatment/Facilities for Individuals Under 21
Type of Recognition: Licensure

5) A psychiatric hospital must be accredited by the Joint Commission on the Accreditation of Health Care Organizations to provide services to program participants under 21 years of age or be Medicare certified to provide services to program participants 65 years of age and older. Distinct part psychiatric units and psychiatric hospitals located in the State of Illinois, or within a 100 mile radius of the State of Illinois, must execute an interagency agreement with a Department of Human Services (DHS) operated mental health center (State-operated facility) for coordination of services including, but not limited to, crisis screening and discharge planning to ensure linkage to aftercare services with private practitioners or community mental health services, as described in subsection (a)(6) of this Section.

State: Illinois
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: 89 IL ADC 590.60 
Setting/Service: Services for Individuals with Mental or Physical Disabilities
Type of Recognition: Licensure

To be qualified to provide the services specified in Section 590.40 of Part, the following shall apply:

b) Hospitals used to provide services to customers under this Part must be approved by the Joint Commission on Accreditation of Hospitals.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: 405 ILCS 30/3
Setting/Service: Mental Health and Substance Abuse Treatment Services
Type of Recognition: Licensure

(d-5) Accreditation requirements for providers of mental health and substance abuse treatment services. Except when the federal or State statutes authorizing a program, or the federal regulations implementing a program, are to the contrary, accreditation shall be accepted by the Department in lieu of the Department's facility or program certification or licensure onsite review requirements and shall be accepted as a substitute for the Department's administrative and program monitoring requirements, except as required by subsection (d-10), in the case of:

(1) Any organization from which the Department purchases mental health or substance abuse services and that is accredited under any of the following: the Comprehensive Accreditation Manual for Behavioral Health Care (Joint Commission on Accreditation of Healthcare Organizations (JCAHO)); the Comprehensive Accreditation Manual for Hospitals (JCAHO); the Standards Manual for the Council on Accreditation for Children and Family Services (Council on Accreditation for Children and Family Services (COA)); or the Standards Manual for Organizations Serving People with Disabilities (the Rehabilitation Accreditation Commission (CARF)).

(2) Any mental health facility or program licensed or certified by the Department, or any substance abuse service licensed by the Department, that is accredited under any of the following: the Comprehensive Accreditation Manual for Behavioral Health Care (JCAHO); the Comprehensive Accreditation Manual for Hospitals (JCAHO); the Standards Manual for the Council on Accreditation for Children and Family Services (COA); or the Standards Manual for Organizations Serving People with Disabilities (CARF).

(3) Any network of providers from which the Department purchases mental health or substance abuse services and that is accredited under any of the following: the Comprehensive Accreditation Manual for Behavioral Health Care (JCAHO); the Comprehensive Accreditation Manual for Hospitals (JCAHO); the Standards Manual for the Council on Accreditation for Children and Family Services (COA); the Standards Manual for Organizations Serving People with Disabilities (CARF); or the National Committee for Quality Assurance. A provider organization that is part of an accredited network shall be afforded the same rights under this subsection.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Human Services
State Reference: 20 ILCS 1705/15.2
Setting/Service: Adult Developmental Training Day Services
Type of Recognition: Licensure

The Department shall annually certify that adult developmental training day services providers meet minimum standards. The Department may determine that providers accredited under nationally recognized accreditation programs are deemed to have met the standards established by the Department under this Section. The Department shall, at least quarterly, review the services being provided to assure compliance with the standards. The Department may suspend, refuse to renew or deny certification to any provider who fails to meet any or all such standards, as provided by rule.

State: Illinois
Program: Disease-Specific Care
Agency: Department of Public Health
State Reference: 40 Ill. Reg. 8274, effective June 3, 2016
Setting/Service: Comprehensive Stroke Centers Primary Stroke Centers Acute Stroke Ready Centers
Type of Recognition: Licensure/Designation

Section 515.5016 Request for Comprehensive Stroke Center Designation

a) A hospital that is already certified as a CSC by a nationally recognized certifying body approved by the Department shall send a copy of the certificate and annual fee to the Department along with an application available through the Department. (Section 3.117(a-5)(1) and (2) of the Act)

Section 515.5030 Request for Primary Stroke Center Designation

a) A hospital that is already certified as a Primary Stroke Center by a nationally recognized certifying body approved by the Department shall send a copy of the certificate and annual fee to the Department, along with an application available through the Department. (Section 3.117(a)(2) of the Act)

Section 515.5085 Request for Acute Stroke-Ready Hospital Designation with National Certification

a) The Department shall require a hospital that is already certified as an Acute Stroke-Ready Hospital, through a Department-approved certifying body, to send a copy of the certificate to the Department. (Section 3.117(b)(4)(A-5) of the Act)


State: Illinois
Program: Hospitals
Agency: Department of Public Health
State Reference: 77 IL ADC 250.130 
Setting/Service: Hospital
Type of Recognition: Licensure

c) Inspections

1) All hospitals to which these requirements apply shall be subject to inspection by personnel of the Department, or by such other persons, including full-time local health officers, as the Department may designate. The licensee or person representing the licensee in the hospital shall provide the representative of the Department with any requested hospital records, assist in inspecting the premises, and secure information required by the Act or Requirements.

2) The Department shall make or cause to be made such inspections and investigations as it deems necessary.

3) Hospitals are authorized to submit a copy of the Joint Commission's survey report, certification and accreditation, interim self-evaluation report and Plan of Correction to the Department.

4) Information contained in reports of surveys made by the Joint Commission on Accreditation of Hospitals and information gained from reports of surveys or transmittals of information from the various Divisions of the Department or State Agencies may be used in determining the need for inspections for compliance with licensing requirements. All such reports provided to the Department for this purpose shall be considered confidential information as provided in Section 9 of the Act.


State: Illinois
Program: Laboratory
Agency: Department of Public Health
State Reference: 77 IL ADC 450.30 
Setting/Service: Laboratory
Type of Recognition: Licensure

c) The following are not required to obtain a permit or be licensed under the Clinical Laboratory Act: 1) Clinical laboratories operated by the United States Government. 2) Clinical laboratories located in hospitals licensed under the Hospital Licensing Act that are under the control of the governing board of such hospitals owned by the exact same entity identified as owner/operator of the hospital as indicated on the last hospital license application filed with the Department; located at the same site and contiguous with the hospital; subject to the regulations and hospital by-laws; and where the entity which receives payment for the laboratory services is the same entity that owns the hospital.

State: Illinois
Program: Nursing Care Center
Agency: Department of Public Health
State Reference: 210 ILCS 45/3-805
Setting/Service: Long-Term Care Facilities
Type of Recognition: Licensure

(a) The Department shall conduct a pilot project to examine, study and contrast the Joint Commission on the Accreditation of Health Care Organizations (“Commission”) accreditation review process with the current regulations and licensure surveys process conducted by the Department for long-term care facilities. This pilot project will enable qualified facilities to apply for participation in the project, in which surveys completed by the Commission are accepted by the Department in lieu of inspections required by this Act, as provided in subsection (b) of this Section. It is intended that this pilot project shall commence on January 1, 1990, and shall conclude on December 31, 2000, with a final report to be submitted to the Governor and the General Assembly by June 30, 2001.

(b)(1) In lieu of conducting an inspection for license renewal under this Act, the Department may accept from a facility that is accredited by the Commission under the Commission's long-term care standards the facility's most recent annual accreditation review by the Commission. In addition to such review, the facility shall submit any fee or other license renewal report or information required by law. The Department may accept such review for so long as the Commission maintains an annual inspection or review program. If the Commission does not conduct an on-site annual inspection or review, the Department shall conduct an inspection as otherwise required by this Act. If the Department determines that an annual on-site inspection or review conducted by the Commission does not meet minimum standards set by the Department, the Department shall not accept the Commission's accreditation review and shall conduct an inspection as otherwise required by this Act.


State: Illinois
Program: Ambulatory Health Care
Agency: Department of Public Health
State Reference: 210 ILCS 3/1
Setting/Service: Birthing Center
Type of Recognition: Licensure/Certification

In adopting rules for birth centers, the Department shall consider: the American Association of Birth Centers' Standards for Freestanding Birth Centers; the American Academy of Pediatrics/American College of Obstetricians and Gynecologists Guidelines for Perinatal Care; and the Regionalized Perinatal Health Care Code. The Department's rules shall stipulate the eligibility criteria for birth center admission. The Department's rules shall stipulate the necessary equipment for emergency care according to the American Association of Birth Centers' standards and any additional equipment deemed necessary by the Department. The Department's rules shall provide for a time period within which each birth center not part of a hospital must become accredited by either the Commission for the Accreditation of Freestanding Birth Centers or The Joint Commission.


State: Illinois
Program: Behavioral Health Care
Agency: Department of Public Health
State Reference: CH 77; Ic 380.730
Setting/Service: SPECIALIZED MENTAL HEALTH REHABILITATION FACILITIES CODE
Type of Recognition: Licensure

Section 380.730  Requirements for Accreditation

a)         At the end of the provisional licensure period established in the Act, the Department shall license a facility as a specialized mental health rehabilitation facility under the Act that successfully completes and obtains valid national accreditation in behavioral health from a recognized national accreditation entity and complies with this Part.  (Section 4-201 of the Act  The license shall be good for one year and shall be renewable annually provided the facility is in substantial compliance with the Act, this Part.

b)         To achieve accreditation, all levels of service that are operated by the licensee and funded in whole or in part by the State shall comply with nationally recognized standards of care as set by one of the following or their successor accreditation standards:

     1)         Standards for Behavioral Health Care (Joint Commission);

     2)         Behavioral Health Standards Manual (Commission on Accreditation of Rehabilitation Facilities (CARF)); or

3)         Accreditation Requirements for Behavioral Health Centers (Healthcare Facilities Accreditation Program).

c)         The facility shall demonstrate current accreditation status by submission of a certificate of accreditation and the most recent accreditation report to the certifying State agency and to the Department.

d)         If the facility's accreditation is suspended, lost or discontinued, the provider shall notify the certifying State agency and the Department of that change immediately.


State: Illinois
Program: Ambulatory Health Care
Agency: Department of Public Health
State Reference: 77 Ill. Adm. Code 205
Setting/Service: Ambulatory Surgical Center
Type of Recognition: L/C

Addition to Licensing Requirements.

An ambulatory surgical treatment center that elects to have an agreement with the federal Centers for Medicare and Medicaid Services, as provided in 42 CFR 416, must also meet the Medicare conditions as an ambulatory surgical center, as set forth in 42 CFR 416, and have an active agreement with the federal Centers for Medicare and Medicaid Services to participate in Medicare as an ambulatory surgical center provider in Illinois. (Section 6.8 of the Act).

The Joint Commission maintains a listing of state agencies that recognize accreditation/certification. These lists have been compiled from a variety of sources and are intended to identify state regulatory agencies that recognize and/or rely on accreditation in lieu of specific state licensure or certification requirements. The Joint Commission makes no claims about the accuracy of this list and it should be considered a reference document. Joint Commission accredited organizations are strongly encouraged to inquire with their state regulatory agency for a full description of the recognition and any additional requirements the state agency may have.