reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.20 - Conduct of Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) All
				hearings will be conducted in the county in which the appellant resides.
				However, if the appellant is outside the state, the hearing officer may take
				depositions from him and his witnesses or permit the appellant to present all
				relevant matter in support of his claim through witnesses acting in his behalf,
				or both by deposition or testimony of witnesses, depending upon the
				circumstances in each case.
b) All
				hearings will be conducted by:
1) An impartial
				hearing officer authorized by the Director of the Department to consider issues
				under appeal by AABD, AFDC, Food Stamp, AMI, or MANG clients, or GA clients in
				the City of Chicago. The hearing shall be conducted in the county in which the
				appellant resides or another county acceptable to the appellant.
2) A Public Aid Committee for GA appeals
				outside the City of Chicago.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.21 - Representation

Current through Register Vol. 48, No. 28, July 12, 2024
a) The appellant
				may represent himself at the hearing or may be represented by legal counsel or
				other authorized representative and need not be present at the hearing. Action
				or inaction of an authorized representative shall be deemed to be action or
				inaction of the appellant.
b) If
				the appellant is not present at the hearing, a written, signed authorization
				designating the representative to serve in said capacity shall be required if:
1) the representative is an employee, agent,
				or representative of a hospital;
2)
				the representative is an employee, agent, or representative of a group care
				facility; or
3) the hearing
				officer, in his judgment, has reason to question the representative's authority
				to serve in said capacity.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.22 - Appellant Participation in Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
The appellant and/or his representative shall have the
				  opportunity to:
a) Examine the
				appellant's case record and obtain copies of case record material upon payment
				of a charge for reproduction. For food stamp appeals, copies of the parts of
				the case record which are relevant to the hearing shall be provided free if
				requested by the appellant or authorized representative.
b) Present evidence and witnesses in their
				behalf.
c) Refute testimony or
				other evidence and cross-examine witnesses.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.23 - Evidentiary Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
The hearing shall not be bound by common law or statutory
				  rules of evidence, or by technical or formal rules of procedure, but shall be
				  conducted in a manner best calculated to conform to substantial
				  justice.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.30 - Subpoenas

Current through Register Vol. 48, No. 28, July 12, 2024
a) Subpoenas may be
				requested by the appellant and/or his representative prior to and/or at the
				hearing. Subpoenas may be granted at the discretion of the hearing
				officer.
b) The hearing officer may
				defer ruling on a request for a subpoena until after available evidence has
				been gathered and heard at the hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.35 - Amendment of Appeal

Current through Register Vol. 48, No. 28, July 12, 2024
A request to amend an appeal may be made in writing prior to
				  the hearing, or at the hearing. The appeal may be amended only if, in the
				  judgment of the hearing officer, the amendment is germane to the subject matter
				  of the original request for an appeal hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.40 - Consolidation of Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department may consolidate a number of individual appeals for the purpose of
				conducting a single group hearing if it is determined that all of the appeals
				involve the same complaint, and the only issue in question is one of:
1) State or Federal law or policy, or changes
				in State or Federal law or policy by AABD, AFDC, or MANG appellants.
2) State law or policy, or changes in State
				law or policy by GA or AMI appellants.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.45 - Postponement or Continuation of Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department may postpone or continue a
				hearing as provided in this Section. As used in this Section, a "postponement"
				is a decision not to convene the hearing on its scheduled date and a
				"continuance" is a decision not to proceed with a hearing that has
				convened.
b) A request to postpone
				or continue a hearing may be made prior to or at the hearing, and should be
				made as soon as the party or representative becomes aware that good cause might
				exist for either not appearing for, or not proceeding with, the hearing. See
				subsection (b)(2) for what constitutes "good cause".
1) All requests for postponement made prior
				to the hearing must be directed to the Assistance Hearings Section. Except for
				the first postponement at the appellant's request of a food stamp appeal, all
				requests for postponement made prior to the hearing must be in
				writing.
2) The first postponement
				or continuance at the appellant's request of a food stamp appeal does not
				require a showing of good cause. All other requests for postponement made prior
				to the hearing ordinarily will be granted in advance of the hearing only when
				the party or representative shows that he has good cause for not appearing for
				that hearing for reasons such as illness or similar circumstances beyond his
				reasonable control.
3) At the
				hearing, the hearing officer may grant a request to continue the hearing when
				the party or representative shows that good cause exists for not proceeding
				with the hearing. If the request to continue the hearing is based on the
				unavailability of witnesses and/or documentary evidence, the hearing officer
				may defer ruling on the request until after the available evidence on the
				issues of the case has been presented.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.50 - Withdrawal of Appeal

Current through Register Vol. 48, No. 28, July 12, 2024
An appeal may be withdrawn by the appellant and/or his
				  authorized representative either prior to or at the hearing. A withdrawal must
				  be in writing and signed by the appellant and/or representative, or on the
				  record during the hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.55 - Closing of Hearing Record

Current through Register Vol. 48, No. 28, July 12, 2024
At the adjournment of the hearing, the record shall be closed
				  and no further evidence may be submitted by the Department or the appellant
				  unless, prior to the adjournment of the hearing, a request to leave the record
				  open for a specified period for the submittal of additional evidence was made
				  by the Department and/or the appellant and granted by the hearing
				  officer.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.60 - Dismissal of Appeal

Current through Register Vol. 48, No. 28, July 12, 2024
a) In the event
				appellant and/or his authorized representative does not appear at the time,
				date and place designated for the hearing, the appeal shall be deemed abandoned
				and shall be dismissed.
b) Refusal
				of the appellant and/or his authorized representative to proceed with the
				hearing shall be deemed a non-appearance, and the appeal shall be deemed
				abandoned and shall be dismissed.
c) The appellant and/or his authorized
				representative shall be informed of the dismissal by written notice.
d) Request to vacate a dismissal must be in
				writing and signed by the appellant and/or his authorized representative. Such
				requests must be received by the Department not more than 10 calendar days
				subsequent to the date of the dismissal notice.
e) Dismissals shall be vacated only if good
				cause for non-appearance is shown. Good cause is defined as:
1) death in the family,
2) personal injury or illness which
				reasonably prohibits the appellant from attending the hearing, and/or
3) sudden and unexpected
				emergencies.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.70 - Final Administrative Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) Following the hearing, a Final
				Administrative Decision will be made by the Director of the Department which
				either upholds or does not uphold the appealed action or determines that the
				Department lacks jurisdiction. A copy of the decision shall be mailed to the
				appellant and his authorized representative, if any.
b) A decision on appeal shall be given the
				interested parties within 60 days from the date of the filing of the appeal
				unless additional time is required for a proper disposition of the appeal in
				AABD, AFDC, MANG, Food Stamp, GA, and AMI cases.
c) When the appealed action is not upheld,
				the Department shall take appropriate action, in accordance with the decision,
				including authorization of retroactive assistance benefits, if
				necessary.
d) Appropriate action
				implementing the results of the decision shall be taken within 90 days from the
				date of initiation of the appeal, extended by any delay in the hearing caused
				by the appellant. In Food Stamp cases, if the decision results in an increase
				in household benefits, the increase shall be reflected in the coupon allotment
				within 10 days of receipt of the hearing decision. If the decision results in a
				decrease of food stamp benefits, the decrease shall be reflected in the next
				scheduled issuance following receipt of the hearing decision.
e) When an appellant whose assistance has
				been continued unchanged as a consequence of a request for a hearing does not
				appear at a scheduled hearing, and fails to advise the Department or Public Aid
				Committee of his inability to attend, the Department shall proceed with the
				planned change in assistance/food stamp benefits, unless the Department
				determines that there was good cause as defined in Section
				104.60 for
				the non-appearances.
f) If an
				appellant dies before the date of hearing, the appeal process may be pursued by
				someone acting responsibly in the appellant's behalf.
g) Once a final decision is released by the
				Department or Committee, it is reviewable only through the Circuit Courts of
				the State of Illinois.
h) No
				petition for rehearing or reconsideration is allowed. Neither the filing of any
				such motion, or correspondence in the nature of such a motion, nor any response
				by the Department to such correspondence or motion will delay the time for
				filing of a complaint in the Circuit Court.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.74 - Surety Bonds

Current through Register Vol. 48, No. 28, July 12, 2024
a) Effective
				July 1, 2012, the following individuals and entities may be required to post a
				surety bond as part of a condition of enrollment or participation in the
				Medical Assistance Program:
1) a vendor or a
				prior vendor who has been terminated, excluded or suspended from the Medical
				Assistance Program, or from another state or federal medical assistance or
				health care program;
2) any
				individual currently or previously barred from the Medical Assistance Program,
				or from another state or federal medical assistance or health care program, as
				a result of being an officer or a person owning, directly or indirectly, 5% or
				more of the shares of stock or other evidences of ownership in a corporate or
				limited liability company vendor during the time of any conduct that served as
				the basis for that vendor's termination, suspension or exclusion;
3) a vendor or a prior vendor who has a debt
				owed to the Department;
4) any
				individual currently or previously barred from the Medical Assistance Program,
				or from another state or federal medical assistance or health care program, as
				a result of being an officer or a person owning, directly or indirectly, 5% or
				more of the shares of stock or other evidences of ownership in that corporate
				or limited liability company vendor who has a debt owed to the Department, when
				the individual was in that position during the time of any conduct that served
				as the basis for the vendor's debt; or
5) vendors, individuals or entities that
				demonstrated previous poor performance or conduct who pose a risk of fraud,
				waste, abuse or harm, as defined in 89 Ill. Adm. Code
				140.13.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.75 - Immediate Suspension of a Vendor

Current through Register Vol. 48, No. 28, July 12, 2024
a) Effective July 1, 2012, anything in this
				Part to the contrary notwithstanding, upon making a determination based upon
				information in the possession of the Department that continuation of
				participation in the Medical Assistance Program by a vendor would constitute an
				immediate danger to the public, the Department may immediately suspend the
				vendor's participation in the Medical Assistance Program without a prior
				hearing.
b) In instances in which
				the Department immediately suspends the Medical Assistance Program
				participation of a vendor under subsection (a):
1) The Department shall notify the vendor of
				the action in writing.
2) A hearing
				upon the vendor's participation shall be convened by the Department within 15
				days after suspension and completed without appreciable delay.
3) The sole issue at hearing shall be held to
				determine whether to recommend to the Department Director that the vendor's
				Medical Assistance Program participation be denied, terminated, suspended,
				placed on provisional status or reinstated.
4) The standard of proof at the hearing shall
				be a preponderance of the evidence.
5) Any evidence relevant to the vendor
				constituting an immediate danger to the public may be introduced against the
				vendor. The vendor, or his or her counsel, shall have the opportunity to
				discredit, impeach and submit evidence rebutting the evidence.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart A - ASSISTANCE APPEALS › Section 104.80 - Public Aid Committee

Current through Register Vol. 48, No. 28, July 12, 2024
In each county a Public Aid Committee to consider appeals
				  shall be with the following composition:
a) In counties under township organization
				(except Cook County), the Committee shall consist of the Chairman of the County
				Board and four County Board members.
b) In Cook County, the Public Aid Committee
				shall consist of five Supervisors of General Assistance appointed by the
				President of the Cook County Board of Commissioners from townships outside the
				City of Chicago.
c) In Commission
				form counties, the Public Aid Committee shall consist of the County Board of
				Commissioners.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart B - RESPONSIBLE RELATIVE AND JOINT PAYEE PETITIONS › Section 104.100 - Support Order, Responsible Relative and Joint Payee Petitions

Current through Register Vol. 48, No. 28, July 12, 2024
Sections
				  104.101
				  through
				  104.104 apply to all
				  petitions of responsible relatives and clients for release from or modification
				  of Administrative Support Orders and to all petitions of responsible relatives
				  to contest determinations of the amount of past-due support or of the share of
				  jointly-owned funds (see 89 Ill. Adm. Code
				  160.70 ), or to contest
				  withholding, or to modify, suspend, terminate, or correct terms contained in
				  administrative income withholding notices (see 89 Ill. Adm. Code
				  160.60(d)(6)
				  ); except that Section
				  104.110
				  shall apply to all petitions of joint owners of personal property and accounts
				  held in financial institutions where the personal property and accounts are
				  subject to levy under 89 Ill. Adm. Code
				  160.70(g)(2).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart B - RESPONSIBLE RELATIVE AND JOINT PAYEE PETITIONS › Section 104.102 - Conduct of Administrative Support Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) Hearing De Novo
1) The hearing shall be de novo and the
				Department's determination of liability or non-liability pursuant thereto shall
				be independent of the prior determination of liability.
2) In Title IV-D cases, the hearing shall
				only consider such matters as are relevant for a determination of the duty and
				financial ability to support under 89 Ill. Adm. Code
				160.60
				and
				160.65.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart B - RESPONSIBLE RELATIVE AND JOINT PAYEE PETITIONS › Section 104.103 - Conduct of Hearings to Contest the Determination of Past-Due Support or of a Failure of a Licensee to Comply with a Subpoena or Warrant in a Paternity or Child Support Proceeding or of Share of Jointly-Owned Federal or State Income Tax Refunds or Other Joint Federal or State Payments

Current through Register Vol. 48, No. 28, July 12, 2024
a) Hearings on petitions to contest the
				determination of the amount of past-due support or of the share of
				jointly-owned federal or State income tax refunds or other joint federal or
				State payments shall be governed by Section
				104.102, except that
				subsections (a) and (c) shall not apply, and the following terms as used in
				Section
				104.102 are
				redefined:
1) "administrative support order"
				shall mean determinations of past-due support or of failure of a licensee to
				comply with a subpoena or warrant in a paternity or child support proceeding or
				of share of jointly-owned federal or State income tax refunds or other joint
				federal or State payments.
2)
				"responsible relative" shall also mean joint payee.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart B - RESPONSIBLE RELATIVE AND JOINT PAYEE PETITIONS › Section 104.104 - Conduct of Other Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Hearings on petitions to contest withholding, or to modify, suspend, terminate,
				or correct a term contained in an administrative income withholding notice or
				an administrative National Medical Support Notice, shall be governed by Section
				104.102, except that
				subsections (a)(2) and (c) shall not apply, and the following terms as used
				therein are redefined:
1) "administrative
				support order" shall mean an administrative income withholding notice or an
				administrative National Medical Support Notice.
2) "liability" shall mean the accuracy of the
				income withholding notice or the National Medical Support Notice, or the
				accuracy of the delinquency amount stated in the income withholding notice
				based upon the administrative support order, or the force and effect to be
				given to such income withholding notice, each as referred to for judicial
				orders for withholding in 89 Ill. Adm. Code
				160.75(d),
				(e), (j) and (n), or for judicial National
				Medical Support Notices under 89 Ill. Adm. Code
				160.75(m).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart B - RESPONSIBLE RELATIVE AND JOINT PAYEE PETITIONS › Section 104.105 - Conduct of Hearings on Petitions for Release from Administrative Paternity Orders

Current through Register Vol. 48, No. 28, July 12, 2024
a) Hearings on
				petitions filed under authority of 89 Ill. Adm. Code
				160.61(e)
				for release from an administrative paternity order entered under 89 Ill. Adm.
				Code
				160.61(b)
				or (c)  shall be governed by Section
				104.102, except that
				subsections (a) and (c) shall not apply, and the hearing shall consider only
				the issues of whether there is a prima facie showing that the petition is
				timely filed, whether the Department's policies and procedures were followed in
				entering the administrative paternity order, whether the petitioner has a
				meritorious defense to entry of the order and whether the petitioner exercised
				due diligence in presenting that defense to the Department.
b) In order to prevail on a timely filed
				petition for release from entry of an administrative paternity order, the
				petitioner must prove a meritorious defense and exercise of due diligence by
				clear and convincing evidence.
c)
				Relief under this Section shall be available only to the extent allowed under
				Section 2-1401 of the Civil Practice Law [735
				ILCS 5/2-1401 ].
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart B - RESPONSIBLE RELATIVE AND JOINT PAYEE PETITIONS › Section 104.106 - Conduct of Hearings on Petitions for Family Financial Responsibility Driving Permits

Current through Register Vol. 48, No. 28, July 12, 2024
a) Hearings on
				petitions filed by responsible relatives aggrieved by the Department's
				determination regarding a request for issuance of a family financial
				responsibility driving permit under 89 Ill. Adm. Code
				160.70(m)
				shall be:
1) de novo, and the Department's
				decision on the petition shall be
independent of the prior determination; and
2) governed by Sections
				104.10
				through
				104.70,
				except that "appellant" as used within this Part shall refer to the responsible
				relative who petitions as set out in subsection (b).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.200 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
Sections
				  104.200 through
				  104.330
				  apply to the Medical Assistance Program described and defined in Chapter 23 of
				  the Illinois Revised Statutes.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.202 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purpose of this Part, the terms "Vendor", "Entity",
				  "Alternate Payee", and "Department policy" shall be as defined at 89 Ill. Adm.
				  Code
				  140.13. "Ground
				  Ambulance Service Provider" shall be as defined at 89 Ill. Adm. Code
				  140.490(a)(1).
				  A Ground Ambulance Service Provider is a "Vendor" as that term is applied in
				  this Part unless otherwise specified.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.204 - Notice of Denial of an Application

Current through Register Vol. 48, No. 28, July 12, 2024
a) If the Department denies an application to
				participate in the Medical Assistance Program, or denies a request for special
				permission to continue participation or for reinstatement in the Program, it
				shall notify the vendor in writing, setting forth:
1) the reasons for the Department's
				decision,
2) a statement of the
				right to request a hearing,
3) a
				statement of the time, place and nature of the hearing, if one is
				requested,
4) a statement of the
				legal authority and jurisdiction under which the hearing is to be held,
				and
5) a reference to the
				particular sections of the statutes and rules involved.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.205 - Notice of Informal Review of the Request for Appeal for Ambulance Service Provider

Current through Register Vol. 48, No. 28, July 12, 2024
a) Requests
				for informal review of the request for appeals filed by an Ambulance Service
				Provider under 89 Ill. Adm. Code
				140.491(j)
				shall proceed pursuant to this Section.
b) The informal review of the request for
				appeal process is initiated by the Ambulance Service Provider filing a written,
				signed request for an informal review of the request for appeal with the
				Department's Bureau of Professional and Ancillary Services or its authorized
				agent, within 90 calendar days after the date of service pursuant to 89 Ill.
				Adm. Code
				140.491(j).
c) The request for informal review of the
				request for appeal shall include:
1) a copy
				of the decision issued by the Department or its authorized agent pursuant to 89
				Ill. Adm. Code
				140.491(j);
2) a brief statement of the issue on appeal;
				and
3) documentation supporting the
				appeal request. The Department shall consider any documentation supporting
				medical necessity, including documentation not previously submitted. Any
				documentation that was not previously submitted to the Department or its
				authorized agent prior to the decision rendered in 89 Ill. Adm. Code
				140.491(j)
				must be designated as not having been previously submitted.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.206 - Notice of Intent to Recover Money

Current through Register Vol. 48, No. 28, July 12, 2024
a) Institutional Vendors
1) For purposes of this Section,
				institutional vendors means providers enrolled in the Medical Assistance
				Program to provide inpatient or residential services, such as hospitals and
				long term care facilities.
2) The
				Department shall notify the institutional vendor in writing of an intent to
				recover money, setting forth:
A) the reason
				for the Department's action;
B) a
				statement of the right to request a hearing;
C) a statement of the time, place and nature
				of the hearing;
D) a statement of
				the legal authority and jurisdiction under which the hearing is to be held;
				and
E) a reference to the Sections
				of the statutes and rules involved.
3) For institutional vendors, the Department
				will not recover money prior to the issuance of a final administrative
				decision, unless the Department determines that the recovery of money would be
				in jeopardy if the recovery does not occur prior to the completion of the
				hearing due to events such as, but not limited to, pending decertification of
				the provider or the filing of a False Claims Act (
				31
				USC 3729 ) action against the provider. In
				these circumstances, the Department may recover the money prior to the
				completion of the hearing, and the notice shall set forth:
A) the date after which the Department will
				start to recover money by deducting from Department obligations to the
				vendor;
B) a statement that the
				Department will recover the money in this manner prior to the completion of any
				hearing requested;
C) a statement
				that any money so recovered will be repaid to the vendor if it is determined at
				hearing that the recovery was not warranted; and
D) a statement that the vendor has the
				opportunity to respond prior to the date the Department will start to recover
				money during the pendency of the hearing and a statement of how and to whom a
				response should be made.
4) Nothing in this subsection (a), except as
				provided in subsection (a)(3), shall preclude a vendor who is enrolled to
				provide inpatient or residential services from voluntarily having the
				Department recover money by deducting from Department obligations to the vendor
				all or part of the claimed overpayment prior to the completion of any
				hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.207 - Notice of Contested Paternity Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
a) In a matter referred to a Department
				Hearing Officer pursuant to 89 Ill. Adm. Code
				160.61(c)(3)
				for a contested paternity hearing, the Department shall notify the alleged
				father of the hearing in writing, setting forth:
1) the time, place and nature of the
				hearing;
2) the legal authority and
				jurisdiction under which the hearing is to be held;
3) a reference to the particular Sections of
				the substantive and procedural statutes and rules involved;
4) the consequences of the failure to appear
				at the hearing; and
5) the Title
				IV-D case name and identification number, the names and birthdates of the
				children he is alleged to have fathered and the name of the mother.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.208 - Notice of Intent to Terminate, Suspend, Exclude or Not Renew Provider Agreement or to Revoke Alternate Payee

Current through Register Vol. 48, No. 28, July 12, 2024
a) Effective July 1, 2012, except for actions
				brought jointly by the Department of Healthcare and Family Services and the
				Department of Public Health pursuant to Section
				104.300, the
				following provisions apply. If, in an action other than one under 89 Ill. Adm.
				Code
				140.16(a)(2),
				under 89 Ill. Adm. Code
				140.16(a)(10)
				 based on a conviction for a violation of
				applicable federal or state law or regulation, or under 89 Ill. Adm. Code
				140.16(c),
				the Department intends to terminate, suspend or exclude a vendor's eligibility
				to participate in the Medical Assistance Program, or terminate (or not renew) a
				vendor's provider agreement, it shall notify the vendor in writing, setting
				forth:
1) the reason for the Department's
				action;
2) a statement of the right
				to request a hearing prior to the intended action taking effect;
3) a statement of the time, place and nature
				of the hearing;
4) a statement of
				the legal authority and jurisdiction under which the hearing is to be held;
				and
5) a reference to the
				provisions of the statutes and rules involved.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.209 - Notice of Intent to Certify Past-Due Support Owed by a Responsible Relative to, or Failure to Comply with a Subpoena or Warrant from, a State Licensing Agency and to Take Disciplinary Action (Repealed)

Current through Register Vol. 48, No. 28, July 12, 2024
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.210 - Right to Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
a) An entity may
				request a hearing within 10 days after the entity's receipt of the Department's
				notice of:
1) the Department's decision to
				deny an application (as provided in Section
				104.204
				);
2) the Department's intent to
				recover money (as provided in Section
				104.206
				);
3) the Department's intent to
				terminate or suspend a vendor's eligibility or terminate (or not renew) a
				vendor's provider agreement or revoke an alternate payee (as provided in
				Section
				104.208
				);
4) the Department's written
				decision issued pursuant to Section
				104.205(d).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.211 - Notice of Termination or Suspension Pursuant to Exclusion by the Department of Health and Human Services

Current through Register Vol. 48, No. 28, July 12, 2024
a) In
				an action under 89 Ill. Adm. Code
				140.16(a)(2)
				 based on the Department of Health and Human
				Service exclusion of an entity from participation in any program under Title
				XVIII or Title XIX of the Social Security Act or any State health care program,
				the Department shall terminate the vendor's eligibility to participate in the
				Medical Assistance Program and terminate the vendor's provider agreement. If
				the exclusion is for a period of less than one year, the Department may suspend
				the vendor's eligibility for a period to coincide with the period of the
				exclusion by the Department of Health and Human Services. The Department shall
				notify the vendor in writing setting forth:
1) the reason for the Department
				action,
2) the effective date of
				the action,
3) a statement that the
				provider may submit in writing prior to the effective date evidence that there
				is no exclusion of the provider, and the name and address of the person to whom
				such evidence is to be sent,
4) a
				reference to the provisions of the statutes and rules involved, and
5) a statement that the action is a final and
				binding administrative decision as of the effective date of the action unless
				the vendor is notified otherwise by the Department prior to the effective
				date.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.212 - Prior Factual Determinations

Current through Register Vol. 48, No. 28, July 12, 2024
Factual determinations made by the Department in
				  administrative hearings initiated prior to the effective date of these Rules
				  and which involve issues of fact relating to activities which constitute
				  grounds for termination pursuant to these Rules may be used as grounds for
				  approval or denial of applications to participate, for termination or
				  suspension of eligibility, or termination (or nonrenewal) of a provider
				  agreement or for recovery of money, without conducting a new administrative
				  proceeding.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.213 - Demand for Judicial Determination of the Existence of the Father and Child Relationship

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
				respondent in a contested paternity hearing may file a demand in writing for a
				judicial determination of the existence of the father and child relationship.
				This demand must be filed no later than 28 days after receipt of the notice
				served pursuant to Section
				104.207.
b) In hearings in which such a demand is
				filed, the Department shall retain jurisdiction over the respondent until
				genetic tests are ordered pursuant to Section
				104.249
				and the results have been received. The Department will refer for judicial
				action in Circuit Court any matter in which a demand for judicial determination
				of the existence of the father and child relationship has been timely
				filed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.215 - Notice of Formal Conference

Current through Register Vol. 48, No. 28, July 12, 2024
When the Department schedules a formal conference, it shall
				  notify the vendor and/or alternate payee in writing. The notice shall direct
				  any parties and/or their attorneys to appear at a specified date, time and
				  place.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.216 - Formal Conference on Recovery of Money

Current through Register Vol. 48, No. 28, July 12, 2024
a) Upon receipt of a request for hearing
				submitted due to the Department's intent to recover money pursuant to Section
				104.206,
				the Department shall schedule a pre-hearing formal conference. This formal
				conference shall commence within 30 days of receipt of such a request unless
				later scheduled with the written consent of all parties.
b) This Section shall not be applicable to
				Department actions to initiate collection of Provider Assessment Taxes under
				the Medicaid Revenue Act (Public Act 87-861).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.217 - Purpose of Formal Conference

Current through Register Vol. 48, No. 28, July 12, 2024
The purposes of the formal conference shall include, but not
				  be limited to:
a) clarification,
				formulation and simplification of issues;
b) resolution of matters in
				controversy;
c) exchange of
				documents and information;
d)
				review of audit findings;
1) An opportunity
				for the vendor and/or alternate payee to rebut the Department's audit findings.
				If the Department's findings were based on sampling and extrapolation, the
				vendor and/or alternate payee may present evidence to show that the sample used
				by the Department was invalid and, therefore, cannot be used to project the
				overpayments identified in the sample to total billings for the audit
				period.
2) The vendor and/or
				alternate payee may also conduct an audit of 100% of the medical records of
				payments received during the audit period and present the result of such an
				audit at the formal conference. Any such audit should demonstrate that the
				vendor's records for the unaudited services provided during the audit period
				were in compliance with the regulations, provider handbooks and other written
				requirements of the Department. The vendor and/or alternate payee should be
				prepared to submit supporting documentation to demonstrate this
				compliance;
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.220 - Notice of Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
When the Department schedules a hearing, it shall notify the
				  parties and/or their attorneys in writing to appear and specify a date, time
				  and place.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.225 - Legal Counsel

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any party may
				appear and be heard at a hearing requested pursuant to
				104.210
				or any formal conference conducted pursuant to Section
				104.216
				through an attorney at law authorized to practice in the State of Illinois or
				any other state. An individual may appear and be heard on his or her own
				behalf.
b) All persons appearing in
				proceedings before the Department shall conform to the standards of conduct of
				attorneys before the courts of the State of Illinois. If a person does not
				conform to such standards, the Department may decline to permit such person to
				appear in any proceeding or exclude such person.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.226 - Appearance of Attorney or Other Representative

Current through Register Vol. 48, No. 28, July 12, 2024
Attorneys or other persons appearing in a representative
				  capacity shall file a written notice of appearance identifying themselves by
				  name, address and telephone number and identifying the party
				  represented.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.230 - Notice, Service and Proof of Service

Current through Register Vol. 48, No. 28, July 12, 2024
a) The chief hearing officer and all parties
				to the proceedings shall be served all papers, notices and other documents
				filed by any party. Proof of such service upon all parties shall be filed with
				the chief hearing officer.
b) Final
				administrative decisions issued pursuant to these Rules as well as any notice
				which initiates administrative proceedings pursuant to these Rules and which
				states that the Department intends to recover money from a vendor, terminate or
				suspend a vendor's eligibility to participate in the Medical Assistance Program
				or terminate, suspend, or not renew a vendor's provider agreement, or deny a
				vendor's application for participation, must be served personally or by
				certified or registered mail upon the vendor or the vendor's agent appointed to
				receive service of process.
c) All
				other papers, notices and documents may be served personally or by deposit in
				the United States mail, properly addressed with postage prepaid, one copy to
				each party entitled thereto.
d)
				When any party or parties have appeared by attorney, service upon the attorney
				shall be deemed service upon the party or parties.
e) Proof of service of any paper shall be by
				certificate of attorney, affidavit or acknowledgement, or certified or
				registered mail return receipt.
f)
				Wherever notice or notification is indicated or required, it shall be effective
				upon the date of mailing to a vendor's or other party's business address,
				residence or last address on file with the Department.
g) In addition to the methods provided for in
				these rules, a vendor may be served in any manner permitted by law.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.231 - Form of Papers

Current through Register Vol. 48, No. 28, July 12, 2024
a) All papers
				filed in any proceeding shall be typewritten on letter sized white paper using
				one side of the paper only. They shall bear a caption clearly showing the title
				of the proceeding in connection with which they are filed, together with the
				docket number, if any.
b) All
				papers shall be signed by the party or his authorized representative or
				attorney, and shall contain his address and telephone number.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.235 - Discovery

Current through Register Vol. 48, No. 28, July 12, 2024
a) There shall be
				no discovery under this Part except for the following items if relevant to the
				case:
1) The Department shall provide, upon
				request, to the vendor:
A) lists of
				witnesses;
B) the provider detail
				report, the drug inventory report, the claim detail report, if
				applicable;
C) in actions against a
				nursing home based upon Department of Public Health surveys, all surveys that
				federal or State regulations require surveyors to complete during the
				investigation;
D) transcripts of
				that portion of peer review committee proceedings wherein the vendor appears,
				not including the committee's deliberations, if applicable;
E) resolutions of a peer review committee
				regarding the vendor, if applicable;
F) any report regarding the vendor prepared
				by the Bureau of Medicaid Integrity's medical consultant witness, if
				applicable; and
G) any exhibits or
				documents that may be identified at hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.240 - Conduct of Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				hearing shall be conducted by an attorney designated by the Director as a
				hearing officer.
b) The hearing
				shall be open to such persons as the hearing officer deems necessary and proper
				for its orderly and efficient conduct.
c) The hearing officer shall inquire fully
				into the matters at issue and shall receive testimony of witnesses and any
				other evidence which is relevant and material to the issues presented. The
				hearing officer shall determine the order in which evidence is taken and the
				procedure at the hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.241 - Amendments

Current through Register Vol. 48, No. 28, July 12, 2024
At any time before completion of the hearing, amendments may
				  be allowed on just and reasonable terms to introduce any party who ought to
				  have been joined, to dismiss any party, or to delete, modify or add allegations
				  or defenses.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.242 - Motions

Current through Register Vol. 48, No. 28, July 12, 2024
A hearing officer may allow oral motions and responses on
				  emergency or purely procedural questions or for good cause shown. Emergency and
				  procedural motions will be ruled upon when made. Other motions, such as motions
				  to dismiss, etc., will not be ruled upon individually but will be considered in
				  preparation of the recommended decision.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.243 - Subpoenas

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any request that
				a Department subpoena issue on behalf of a party to a hearing may be made in
				writing to the designated hearing officer, or if none has been designated, to
				the chief hearing officer.
b) A
				subpoena shall be granted by the Department only upon:
1) a showing of relevancy and reasonable
				scope; and
2) a showing that unless
				the subpoena is issued the party will be unable to produce individuals or
				documents requested by the subpoena; and
3) a showing that the individuals or
				documents requested by the subpoena are not unduly repetitious; and
4) a showing that there are not other
				individuals or documents available to establish the matters which the
				subpoenaed individuals or documents are intended to establish.