Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart I - DISPOSITION OF DETERMINATION › Section 240.920 - Reasons for Denial

Current through Register Vol. 48, No. 28, July 12, 2024
Denial of CCP eligibility shall be based upon 1 or more of
				  the reasons identified in this Section:
a) Participant is less than 60 years of age
				at the time of the determination of eligibility.
b) Participant is not in need of CCP
				services: scored less than 29 total points/less than 15 points on Part A, Level
				of Impairment, of the DON.
c)
				Participant/legal guardian/authorized representative refuses to sign the
				Participant Agreement - Person-Centered Plan of Care.
d) Participant/authorized representative does
				not agree with the person-centered plan of care/hours of service and an
				agreement could not be reached during the person-centered planning
				process.
e) Participant is
				deceased.
f) Participant has been
				institutionalized or is not otherwise available for services for more than 60
				calendar days after the date of referral.
g) Participant/authorized representative
				voluntarily withdraws a request.
h)
				Participant cannot be located to determine eligibility for or to provide CCP
				services.
i) Participant/authorized
				representative has not provided reasonable documentation supporting eligibility
				as required by the Department or its CCU within 90 calendar days after the date
				of receipt of referral.
j)
				Participant/authorized representative has not cooperated with the
				Department/CCU/vendor as required and as specified by Section
				240.350.
k) Participant does not meet citizenship
				requirements.
l) Participant does
				not meet residency requirements.
m)
				The CCU determines that an adequate person-centered plan of care cannot be
				developed that adequately meets the participant's determined needs under
				Section
				240.715.
n) The total value of participant's
				non-exempt assets is in excess of $17,500.
o) Eligibility could not be established for a
				participant who was receiving interim services based upon presumptive
				eligibility as required by Sections
				240.1020
				and
				240.865.
p) Participant/authorized representative
				provided fraudulent information.
q)
				Participant whose request for CCP services was previously denied or whose
				services were terminated for non-cooperation as set forth in Section
				240.350
				shall be denied services upon a subsequent request for services, unless the
				situation or condition that led to the memorandum of understanding (see Section
				240.350) has been permanently resolved.
r) Participant/authorized representative
				refuses to sign the Participant Agreement and Consent Form in accordance with
				Section
				240.330
s) Participant/authorized
				representative has transferred non-exempt assets or failed to report a transfer
				within the past 60 months for the purpose of obtaining CCP services.
t) Participant/authorized representative has
				not reported or refused to provide documentation of changes in circumstances
				that have occurred prior to eligibility determination as required by Section
				240.360.
u) Participant/authorized representative
				refuses to apply for and, if eligible, enroll in medical assistance under
				Article V of the Illinois Public Aid Code as required by Section
				240.865.