reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 230 - OLDER AMERICANS ACT PROGRAMS › Subpart G - CASE MANAGEMENT SERVICES › Section 230.650 - Case Coordination Unit Compliance During Contract/Grant Period

Current through Register Vol. 48, No. 28, July 12, 2024
a) Each Case
				Coordination Unit (CCU) receiving a contract/grant from an Area Agency on Aging
				(AAA) must comply with Federal, State and local laws, regulations and
				Department rules, policies and procedures.
b) The AAA shall have the authority to
				conduct a review of a CCU agency at any time during the course of the CCU's
				contract/grant period for the purpose of protecting the health, safety and
				welfare of case management clients.
c) The AAA shall conduct a review in
				accordance with procedures established by the particular AAA pursuant to 89
				Ill. Adm. Code
				220.660
				to ensure statewide continuity. Reviews shall be conducted no less frequently
				than one review during each funded period.
d) Records of a review conducted by the AAA
				shall be maintained by the AAA and corrective action(s), if indicated, shall be
				taken in accordance with established AAA policy and as described in 89 Ill.
				Adm. Code
				220.670
				and
				220.675.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart A - GENERAL PROGRAM PROVISIONS › Section 240.100 - Community Care Program

Current through Register Vol. 48, No. 28, July 12, 2024
The statutory authority for this rule is vested in the
				  Illinois Act on the Aging, as amended. The costs of Community Care Program
				  services provided to all eligible participants who are also enrolled in Medical
				  Assistance Programs administered by the Illinois Department of Healthcare and
				  Family Services (HFS) will be submitted for Federal Financial Participation
				  under provisions of a waiver granted to the State of Illinois relevant to Title
				  XIX of the Social Security Act (Section 1915) (
				  42 USC
				  1396 ). The costs of Community Care Program
				  services provided to all other eligible participants will be borne by
				  appropriations set within the State's budget process.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart A - GENERAL PROGRAM PROVISIONS › Section 240.110 - Department Prerogative

Current through Register Vol. 48, No. 28, July 12, 2024
Other programs or demonstration/research projects may be
				  funded by the Department on a pilot basis. These other programs or
				  demonstration/research projects shall be funded for purposes of providing
				  alternatives to nursing facility care; permitting equal access to Community
				  Care Program services; evaluating the impact of the program on sustaining
				  participants in the community and other funding opportunities for the
				  Department; or for other purposes designated by the Department in the best
				  interest of the Community Care Program and funding opportunities for the
				  Department and other human service agencies through federal and State
				  grant-making activity and waiver applications on behalf of the State of
				  Illinois under Title XIX of the Social Security Act.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart A - GENERAL PROGRAM PROVISIONS › Section 240.120 - Services Provided

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Community Care Program (CCP) provides necessary services designed to prevent
				premature and unnecessary nursing facility care of participants determined
				eligible to receive those services.
b) Services provided through the CCP are:
				in-home care, adult day service, emergency home response, automated medication
				dispenser, information and referral, care coordination, and services made
				available through special demonstration/research projects.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart A - GENERAL PROGRAM PROVISIONS › Section 240.130 - Maintenance of Effort

Current through Register Vol. 48, No. 28, July 12, 2024
Services made available through the Community Care Program
				  shall not supplant the same type of services which are available through other
				  funded sources but shall be utilized for purposes of complementation and
				  coordination of all services available to eligible participants. Therefore,
				  participants are not permitted to be enrolled in another Home and
				  Community-Based Service (HCBS) Waiver.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart A - GENERAL PROGRAM PROVISIONS › Section 240.140 - Program Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
The execution of all activities related to the Community Care
				  Program, as specified in this Part, shall be subject to resources made
				  available to the program through the appropriation process of the State of
				  Illinois.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart A - GENERAL PROGRAM PROVISIONS › Section 240.150 - Program Limitations

Current through Register Vol. 48, No. 28, July 12, 2024
The main address for the Department is:
Illinois Department on Aging
One Natural Resources Way, #100
Springfield IL 62702-1271
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart B - SERVICE DEFINITIONS › Section 240.230 - Adult Day Service (ADS)

Current through Register Vol. 48, No. 28, July 12, 2024
Adult day service is the direct care and supervision of
				  adults aged 60 and over in a community-based setting for the purpose of
				  providing personal attention and promoting social, physical and emotional
				  well-being in a structured setting. These services shall be provided pursuant
				  to an ADS Addendum to the participant's person-centered plan of care.
a) Required Service Components
1) Assessment of the participant's strengths
				and needs and development of an individual written person-centered plan of care
				for each participant that establishes specific participant goals for all
				service components to be provided or arranged for by the service provider.
A) The individual ADS Addendum will be
				developed by the adult day service team consisting of participant/authorized
				representative, Program Coordinator/Director and Program Nurse, and may include
				other staff at the option of the program Coordinator/Director.
B) The participant, caregiver and other
				service providers will have the opportunity to contribute to the development,
				implementation and evaluation of the individualized ADS Addendum.
C) The individualized ADS Addendum is to be
				established not later than the fourth week of service.
D) The individualized ADS Addendum shall
				address the needs identified by the CCU, as described in the comprehensive
				assessment.
E) The individualized
				ADS Addendum to the person-centered plan of care shall address the need
				identified by the service provider's staff and participant/authorized
				representative/caregiver during the individualized ADS Addendum
				process.
F) Reassessing the
				participant's needs and reevaluating the appropriateness of the individualized
				person-centered plan of care shall be done as needed, but at least
				annually.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart B - SERVICE DEFINITIONS › Section 240.235 - Emergency Home Response Service

Current through Register Vol. 48, No. 28, July 12, 2024
a) Service
				Definition
Emergency home response service (EHRS) is defined as a
				  24-hour emergency communication link to assistance outside the participant's
				  home based on the participant's health and safety needs and mobility
				  limitations. This service is provided by a 2-way voice communication system
				  consisting of a base unit and an activation device worn by the participant that
				  will automatically link the participant to a professionally staffed support
				  center. The support center assesses the situation and directs an appropriate
				  response whenever this system is engaged by a participant. The purpose of
				  providing EHRS is to improve the independence and safety of participants in
				  their own homes in accordance with the authorized person-centered plan of care,
				  and thereby help reduce the need for nursing facility care.
b) Specific components of EHRS shall include
				the following:
1) provide a base unit and,
				when necessary, adaptive activation devices, together with all connectors,
				parts and equipment necessary for installation, that can be used in a home by
				up to 2 participants with hearing, mobility and/or visual impairments.
A) Wireless adaptive activation devices
				(e.g., sip and puff, rocking lever switch) must be available when a participant
				cannot physically activate the call button.
B) The system must be useable by visually and
				hearing impaired participants through visual and audible indications of alarm
				activation.
C) Adaptive activation
				devices shall be provided at no extra cost to the participant;
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart B - SERVICE DEFINITIONS › Section 240.237 - Automated Medication Dispenser Service

Current through Register Vol. 48, No. 28, July 12, 2024
a) Service Description
1) AMD service is defined as a portable,
				mechanical system for individual use that can be programmed to dispense or
				alert the participant to take non-liquid oral medications through auditory,
				visual or voice reminders; to provide notification of a missed medication dose;
				and to provide 24-hour technical assistance for the AMD service in the
				participant's residence. The service may include medication specific directions
				or reminders to take other types of medications such as liquid medications or
				injections based on individual need. The AMD unit is connected to a Department
				approved support center through a telephone line or wireless/cellular
				connection in the participant's residence.
2) The purpose of the service is to provide
				eligible participants with medication reminders to foster timely and safe
				administration of a medication schedule, thereby promoting independence and
				safety of all participants in their own residence, as well as reducing the need
				for nursing home care.
3) The
				authorization to receive this service is determined by the care coordinator
				through a screening process set forth in Section
				240.741,
				which requires the participant/authorized representative to designate an
				assisting party to manage the AMD unit and medications as set forth in Section
				240.741.
4) The Department does not
				perform medication management, oversight or handling of the participant's
				medications.
5) Provision of this
				service is contingent upon it continuing to be an approved service under the
				HCBS Waiver for Persons Who are Elderly.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart B - SERVICE DEFINITIONS › Section 240.240 - Information and Referral

Current through Register Vol. 48, No. 28, July 12, 2024
Information and Referral service is defined as assistance to
				  participants to enable them to gain access to appropriate services and to
				  receive services.
a) Service
				components of information and referral include:
1) A brief assessment of the participant's
				needs to facilitate appropriate referral to and follow-up with community
				resources;
2) Assisting
				participants in applying for benefits provided by federal, state and local
				agencies;
3) Follow-up to ensure
				that participant was linked to community-based services and supports;
4) Information and referral may also
				encompass program-related public information efforts.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart B - SERVICE DEFINITIONS › Section 240.250 - Demonstration/Research Projects

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Demonstration/research projects are defined as services designated to test or
				demonstrate, as specified in Section
				240.110,
				effective service delivery to participants 60 years of age and older to
				prevent/reduce the incidence of premature or inappropriate nursing facility
				care. These projects are study programs testing the feasibility of new types of
				services, service delivery methods or service components which, as a result of
				the demonstration/research, will be considered for incorporation in the
				CCP.
b) Unit of Service
A unit of service for a demonstration/research project shall
				  be as stated in each contract/grant executed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart B - SERVICE DEFINITIONS › Section 240.260 - Care Coordination Service

Current through Register Vol. 48, No. 28, July 12, 2024
Care coordination service is defined as the provision of a
				  comprehensive needs assessment and service coordination by CCUs to assist an
				  older person to gain access to and receive needed services. The
				  participant/authorized representative is provided the opportunity to lead the
				  person-centered planning process.
a)
				Service Components
Specific components of care coordination service include the
				  following:
1) Review of all inquiries
				to determine if a request for CCP services is desired, and maintenance of a
				referral request log.
2)
				Distribution and assistance with completion of CCP applications for charitable,
				private, and public benefits provided by federal, State and local agencies,
				including assistance with the initial application and redetermination for
				Medicaid benefits.
3) Performance
				of determinations/redeterminations of eligibility, including a comprehensive
				needs assessment, the development of a person-centered plan of care and
				authorization/referral of CCP services.
4) Completion of a minimum of 1 face-to-face
				contact with the participant in between initial assessment and annual
				reassessment. The face-to-face visit is to occur between 4 and 8 months after
				the last determination or redetermination of eligibility.
5) Reporting of critical events includes
				critical incidents, service improvement program complaints, and requests for
				change of status in the Department's automated reporting system. Completing
				initial critical event reports will occur within 7 days after the date the
				event occurred or was identified to have occurred. All critical event reports
				will be closed to reflect mandatory follow-up with CCP participants within 60
				days after the date the event occurred or was identified to have occurred.
				Critical event report closure will occur through completion of the 60-day
				review summary housed in the Department's automated reporting system.
6) Availability to receive inquiries and
				requests for services and supports, by telephone or in person, and respond to
				those inquiries and requests.
7)
				Choices for Care prescreenings and postscreenings (see Section
				240.1010
				).
8) Department of Healthcare and
				Family Services (HFS) OBRA-1 (Level I ID Screen).
9) Provide referrals to other needed
				services.
10) Implementation of
				services and participant transfers.
11) Authorization of all actions related to
				the disposition of CCP services as required by this Part.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart B - SERVICE DEFINITIONS › Section 240.270 - Alternative Provider

Current through Register Vol. 48, No. 28, July 12, 2024
a) An
				alternative provider is defined as an individual or an agency selected by the
				participant, assisted by the CCU and authorized by the Department to provide
				CCP services to a participant only if the following criteria are met:
1) a contractual provider has failed to
				provide the services as required by the person-centered plan of care;
				and
2) there is no contractual
				provider available to provide the services as required by the person-centered
				plan of care.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.300 - Participant Rights and Responsibilities

Current through Register Vol. 48, No. 28, July 12, 2024
The Department will administer CCP to assure certain rights
				  to participants in accordance with the Home Care Participant Bill of Rights
				  (see 20
				  ILCS 2405/17.1 and 320 ILCS 42/40) and the Medicaid
				  Recipient Bill of Rights (see
				  305 ILCS
				  5/11-28 ). In addition, the Department will assure
				  that participants receive an explanation of their rights and responsibilities.
				  A copy of the rights and responsibilities shall be provided in written format
				  to all participants during the initial visit for determination of eligibility
				  or upon request by the participant.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.310 - Right to Request Services

Current through Register Vol. 48, No. 28, July 12, 2024
Any participant desiring to request CCP services shall have
				  the right to request those services and to receive a written decision relative
				  to that request.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.320 - Nondiscrimination

Current through Register Vol. 48, No. 28, July 12, 2024
a) No eligible
				participant with a disability or protected person under other federal and State
				civil rights laws who requests/receives services may be discriminated against
				under CCP.
b) A
				participant/authorized representative may file a discrimination complaint with
				a vendor, a CCU, the Department, or other federal or State agency with
				jurisdiction over civil rights laws (see 4 Ill. Adm. Code 1725).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.330 - Freedom of Choice

Current through Register Vol. 48, No. 28, July 12, 2024
a) A participant
				has the right to request and, if eligible, to receive available CCP services. A
				participant may choose at any time not to receive services for which
				eligibility has been determined.
b)
				A participant/authorized representative shall be informed of, and have the
				right to choose from, choices regarding available services, supports and
				vendors in the participant's CCU service area:
1) at the time of initial determination of
				eligibility or subsequent redetermination of the participant; or
2) at the time of determination of
				presumptive eligibility for interim services; or
3) at any time the participant/authorized
				representative requests a change of providers/vendors; or
4) at the time of a Department-initiated
				total or partial caseload transfer.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.340 - Confidentiality/Safeguarding of Case Information

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				For protection purposes, any information about a participant's case is
				confidential and may be used only for purposes directly related to the
				administration of the CCP. Information that is considered to be included in the
				administration of the program is as follows:
1) Establishing a participant's
				initial/continuing eligibility, preventing duplicate coverage under another
				Home and Community-Based Service (HCBS) Waiver, and providing assistance in
				transitioning to other programs in appropriate instances.
2) Establishing the extent of a
				participant's: assets and income; determination of need under CCP; and other
				benefits. This includes recovery of payments and investigating allegations of
				fraud or other abuse of publicly funded benefits. This information may be
				shared in a secure manner by and among the Department and the Social Security
				Administration, the Department of Employment Security, HFS, the Department of
				Human Services, the Department of Revenue, the Secretary of State, the U.S.
				Department of Veterans Affairs, and any other governmental entity only to the
				extent that there is no conflict with any federal or State law or
				regulation.
3) Finding and linking
				needed services and resources available to an eligible participant, including
				information about new laws or changes in public benefit programs.
4) Assuring the health, safety, and welfare
				of the participant, including reporting alleged or suspected abuse, neglect,
				financial exploitation, or self-neglect, assisting with investigations
				conducted under the Adult Protective Services Program, and making referrals to
				the State/Regional Long Term Care Ombudsman Programs.
5) Collecting data for the Department's
				demonstration/research projects.
6)
				Compliance with legal proceedings in response to valid court or administrative
				agency orders.
7) Directing and
				planning programming to transform long-term services and supports in Illinois
				and to maximize Federal Financial Participation in State expenditures under
				Medical Assistance Programs.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.350 - Participant/Authorized Representative Cooperation

Current through Register Vol. 48, No. 28, July 12, 2024
Participants/authorized representatives shall cooperate with
				  the representatives of the Department/CCUs/providers in determinations of
				  eligibility, redeterminations, other necessary or required face-to-face visits,
				  or provision of CCP services.
a)
				Failure to cooperate in the actions specified below shall be considered
				non-cooperative and shall be cause for suspension.
1) A participant/authorized representative
				shall notify the office of the provider at least 1 day in advance when the
				participant will not be present in his/her home to receive scheduled services.
A) If the participant's absence from his/her
				home on a day services are scheduled is due to an emergency, the
				participant/authorized representative shall advise the office of the provider
				as quickly as possible and it will not be considered non-cooperative.
B) The provider shall document the absences
				of the participant without prior notification (except any absence caused by an
				emergency) and shall be reimbursed by the Department for 2 such absences (see
				Section
				240.210
				).
C) Two such documented absences
				within a State fiscal year shall be cause for suspension of the participant's
				services pending termination. The provider has the option of not reporting
				non-cooperative absences; however, if the second non-cooperative absence is
				reported with request for reimbursement, suspension procedures shall be
				implemented.
D) The provider shall
				verbally advise the CCU on the same day, if possible, but not later than the
				next work day after the date of the second non-cooperative absence. A written
				report including, at a minimum, the names of the participant and the worker,
				and the dates of the first and second non-cooperative absence, shall be
				submitted by the provider to the CCU within 2 work days after the date of the
				second non-cooperative absence. The written report may be submitted in person
				or through mail, facsimile or electronic means.
E) Upon receipt of verbal notification of the
				second documented non-cooperative absence within a State fiscal year, the CCU
				shall suspend the participant's services as required in Section
				240.930. The date
				of suspension shall be the date that the second non-cooperative absence
				occurred.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.360 - Reporting Changes

Current through Register Vol. 48, No. 28, July 12, 2024
It shall be the responsibility of the participant/authorized
				  representative to report changes in circumstances (including household
				  composition, change of address, change in level of services needed, and
				  enrollment status in the Medical Assistance Program) that might affect
				  eligibility for CCP within 30 calendar days after the effective date of the
				  change. Benefit changes at the federal level that affect a group of
				  participants (such as increases in Social Security payment, etc.) need not be
				  reported by the participant/authorized representative.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart C - RIGHTS AND RESPONSIBILITIES › Section 240.370 - Voluntary Repayment

Current through Register Vol. 48, No. 28, July 12, 2024
Any participant who is receiving or has received services
				  through CCP may voluntarily repay to the State of Illinois any amount up to the
				  total cost expended by the State in providing Community Care services to the
				  participant.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.405 - Representation

Current through Register Vol. 48, No. 28, July 12, 2024
a) The appellant
				may represent him/herself and/or may authorize legal counsel, a relative, a
				friend or other spokesperson to represent him/her.
b) Written authorization is not required
				unless the appellant is not present at the hearing and:
1) the representative is an employee, agent
				or representative of a hospital; or
2) the representative is an employee, agent
				or representative of a group care facility; or
3) the representative is a provider of
				Community Care services or an employee of an Area Agency on Aging; or
4) the Hearing Officer, in his/her judgment,
				has reason to question the representative's authority to serve as a
				representative.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.410 - When the Appeal May Be Filed

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				right to appeal must be exercised within 60 calendar days after the date the
				notice of the action being appealed was sent to the participant advising the
				action being taken by the CCU, such as:
1)
				the date the notice was sent by a CCU of a decision on a request for a
				determination of eligibility for CCP services;
2) the date the notice was sent by a CCU or
				the Department of a reduction or termination of CCP services, except for
				instances involving automatic, non-discretionary changes in eligibility, rates
				or benefits required by federal or State statute or regulation; or
3) the date the notice was sent by a CCU or
				the Department of denial of a request or other action that aggrieves the
				participant, when that denial or action was other than an eligibility
				determination or a decision to reduce or terminate services.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.415 - What May be Appealed

Current through Register Vol. 48, No. 28, July 12, 2024
The following actions of CCUs, providers or the Department
				  may be appealed:
a) Refusal to accept
				a referral for CCP services.
b)
				Failure to act upon a referral form within the mandated time period, unless
				delayed in any manner by the participant/authorized representative in the
				determination of eligibility process.
c) A decision to deny CCP services.
d) Failure to advise prescreened
				participants/authorized representatives that they have a choice of:
1) nursing facility care, if
				eligible;
2) supported living
				program provider care, if eligible;
3) receiving in-home or community-based
				services, if eligible; or
4)
				declining any of these options.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.420 - Group Appeals

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may consolidate a number of participant
				  appeals for the purpose of conducting a single group informal review and
				  subsequent hearing. The consolidation must be based upon the Department's
				  determination that all of the appeals involve the same complaint, and the only
				  issue in question is one of State or federal law or policy. Consideration shall
				  be given to the geographic proximity and the physical condition of the
				  appellants. Each appellant has the option of withdrawing from the group and
				  presenting their appeal individually.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.425 - Informal Review

Current through Register Vol. 48, No. 28, July 12, 2024
When an appeal is received by the Department, the Department
				  shall proceed to conduct an informal review of the action or inaction serving
				  as the basis of the appeal.
a) The
				purpose of an informal review shall be to determine the facts in the appealed
				action or inaction.
b) If the basis
				for the appeal involves the functioning of the participant in his/her
				environment or if the Department is unable to arrive at a decision based upon
				the facts presented, the Department or it's designated agent may conduct a
				face-to-face review in the participant's home.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.430 - Informal Review Findings

Current through Register Vol. 48, No. 28, July 12, 2024
a) Within
				60 calendar days after the date of receipt of the Notice of Appeal to
				Department on Aging form, the Department shall conduct an informal review and
				issue an Appeal Findings Notice that may be delayed pending an extension of
				time caused by the appellant.
b)
				The Appeal Findings Notice shall clearly state the facts determined and
				decision of the Department based upon the informal review. Copies shall be sent
				to all parties to the appeal.
1) If the
				appeal is upheld, based upon the Department decision resulting from the
				informal review, the appeal file shall be closed.
2) If the original action is modified, based
				upon the Department decision resulting from the informal review, the appeal
				shall automatically proceed to hearing unless the appellant/ authorized
				representative withdraws the hearing request in writing.
3) If the appeal is denied, based upon the
				Department decision resulting from the informal review, the appeal shall
				automatically proceed to hearing unless the appellant/ authorized
				representative withdraws the hearing request in writing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.435 - Withdrawing an Appeal

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				appellant/authorized representative, may withdraw the appeal at any time prior
				to or during the appeal process. The withdrawal may be submitted in writing or
				by telephone.
b) The Department
				shall acknowledge the withdrawal of appeal and advise the appellant/authorized
				representative that the appeal is formally closed, in writing, by certified
				mail, return receipt requested.
c)
				The Department shall furnish copies of the acknowledgment of withdrawal to all
				interested parties to the appeal.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.436 - Cancelling an Appeal

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Department may cancel an appeal at any time during the appeal process for any
				of the following:
1) Appellant's
				death;
2) Appellant never received
				a notice of adverse action from the Department;
3) Appellant is not a CCP
				participant;
4) Appellant moves out
				of State;
5) Appellant's appeal is
				upheld by the Department;
6)
				Appellant/ authorized representative does not submit a Notice of Appeal to the
				Department within 60 calendar days after the date the notice of adverse action
				was sent;
7) Appeal is not related
				to any CCP services; and/or
8)
				Appeal is filed by an unauthorized representative.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.440 - Examining Department Records

Current through Register Vol. 48, No. 28, July 12, 2024
Before or during the appeal hearing, if requested, the
				  Department shall permit the appellant/appellant's authorized representative to
				  examine all portions of the case record and any other documents to be used at
				  the hearing. Department records may be examined only in the presence of a
				  Department employee. Copies of case material shall be provided by the
				  Department upon request of the appellant/appellant's authorized representative.
				  A charge of ten (10) cents per sheet shall be made for each copy
				  provided.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.450 - The Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
The hearing will be informal but
the rules of
				  evidence and privilege as applied in civil cases in the circuit courts Circuit
				  Courts of this State shall be followed. Evidence However, evidence not
				  admissible under those such rules of evidence may be admitted, however, (except
				  where precluded by statute) if it is of a type commonly relied upon by
				  reasonably prudent men in the conduct of their affairs.
(Illinois
				  Administrative Procedure Act [
				  5 ILCS
				  100/10-10 through 10 -40]) The proceedings will be
				  recorded. The appellant may present the case or have an authorized
				  representative present it, and may bring witnesses to the hearing. The
				  appellant/ authorized representative shall have the opportunity before and
				  during the hearing to examine material the Department plans to have available,
				  which must include:
a) Statement of
				Facts; and
b) Pertinent case
				information, including all documents to be used at the hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.451 - Conduct of Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
The hearing may be conducted with some or all parties,
				  including the hearing officer, present at different locations connected with
				  each other by telephone.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.455 - Continuance of the Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
a) During
				the hearing, the appellant/authorized representative may request a continuance
				from the Hearing Officer. The continuance shall be granted if:
1) the appellant needs additional
				information;
2) a necessary witness
				is absent;
3) the appellant is
				ill;
4) the appellant's authorized
				representative is unavailable; or
5) for any other reason that necessitates a
				continuance in order for the appellant to present the appeal.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.460 - Postponement

Current through Register Vol. 48, No. 28, July 12, 2024
a) A hearing shall
				be postponed for a reasonable period if:
1)
				the appellant needs additional information;
2) a necessary witness is absent;
3) the appellant is ill;
4) the appellant's authorized representative
				is unavailable; or
5) for any other
				reason that necessitates a postponement in order for the appellant to present
				the appeal.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.465 - Dismissal Due to Non-Appearance

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				If neither the appellant nor the appellant's authorized representative appears
				at the time and place designated for the hearing, and a postponement has not
				been requested in writing, the appeal is considered abandoned and is
				dismissed.
b) The refusal by the
				appellant/authorized representative to proceed with the hearing is considered a
				non-appearance. The appeal is considered abandoned and is dismissed.
c) Dismissal of an appeal is a final
				administrative decision. The Department will make any planned change in
				services, which had been delayed pending the outcome of the appeal, immediately
				upon receipt of written notification from the Hearing Officer and will notify
				all parties to the appeal in writing.
d) The Department will send a written notice
				to the appellant/authorized representative and all parties to the appeal
				advising that the appeal has been dismissed for non-appearance.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.470 - Rescheduling the Appeal Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Within 10 calendar days after the date of the dismissal notice, the
				appellant/authorized representative may submit a written request to reschedule
				the appeal hearing. The written request to reschedule the appeal hearing must
				be sent to the Hearing Section as shown on the Dismissal Notice issued by the
				Hearing Officer. The dismissal will be vacated if good cause can be shown for
				the non-appearance that led to the dismissal. Good cause is defined as:
1) Death in the family;
2) Personal injury or illness that reasonably
				prohibits the appellant from attending the hearing; or
3) Sudden and unexpected
				emergencies.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.475 - Recommendations of Hearing Officer

Current through Register Vol. 48, No. 28, July 12, 2024
The hearing officer shall certify the entire record of the
				  hearing to the Director of the Department and shall recommend a decision on
				  each issue in the hearing. The hearing officer shall not render a final
				  decision relevant to any issue in the hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.480 - The Appeal Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				decision resulting from the appeal shall be made in writing no later than 90
				calendar days after the close of the hearing record. The appellant/authorized
				representative and all other parties to the appeal shall be notified by sending
				to them a copy of the decision by U.S. mail. The decision shall be made by
				applying Department rules to the particular case situation. Appeals shall be
				considered on a case-by-case basis.
b) The final administrative decision shall be
				issued by the Director of the Department and it shall either:
1) uphold or modify the Hearing Officer's
				recommendation in the appeal;
2)
				not uphold the Hearing Officer's recommendation; or
3) determine a lack of Department
				jurisdiction.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart D - APPEALS › Section 240.485 - Reviewing the Official Report of the Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
At any time within 5 years after the date of the release of
				  the Department's final administrative decision, the appellant/authorized
				  representative may review the official report of the hearing. The official
				  report, including documents presented at the proceedings, findings of fact, and
				  findings of law, will be made available by the Department on Aging upon
				  request. The Springfield office of the Department is the only location where
				  the official report of the hearing may be reviewed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart E - REQUEST FOR SERVICES › Section 240.510 - Participant Agreement for Community Care Program

Current through Register Vol. 48, No. 28, July 12, 2024
If an individual is determined eligible for CCP, he/she or an
				  authorized representative shall sign a written Participant Agreement and
				  Consent Form to request services.
a)
				Any participant requesting CCP services orally or in writing, shall be
				contacted by the CCU within 5 calendar days after the date of the
				inquiry/request.
b) The signed
				Participant Agreement and Consent Form will accompany an appropriately
				completed person-centered comprehensive assessment
c) The participant/ authorized representative
				shall be informed in writing of eligibility requirements to receive services
				under CCP and of the participant's right to appeal under this Part.
d) When a participant has a legally appointed
				guardian, the guardian shall sign the Participant Agreement and Consent Form -
				Person-Centered Plan of Care. A legally appointed guardian may serve as the
				"guardian of the person" and/or "guardian of the estate". One legally appointed
				guardian may serve as guardian of the person while a second legally appointed
				guardian may serve as guardian of the estate. If 2 different persons are
				appointed guardian for an individual, one of the person and one of the estate,
				the guardian of the person determines which one is to sign the Participant
				Agreement and Consent Form.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart E - REQUEST FOR SERVICES › Section 240.540 - Statement to be Included on Participant Agreement and Consent Form

Current through Register Vol. 48, No. 28, July 12, 2024
The following statement shall be included on the Participant
				  Agreement and Consent Form:
NOTICE
I understand that a decision regarding my eligibility for
				  Community Care services must be made within 30 calendar days after the date of
				  this completed form (address). I must be notified in writing of the decision
				  within 15 calendar days after it is made, and I will receive services, if I am
				  eligible, within 15 calendar days after the notice of eligibility is mailed to
				  me. However, any delay I cause in failing to provide information requested by
				  the Department on Aging will extend these time limits.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart E - REQUEST FOR SERVICES › Section 240.550 - Person-Centered Planning Process

Current through Register Vol. 48, No. 28, July 12, 2024
A person-centered plan of care will be developed in
				  collaboration with the participant who is eligible for services using a
				  person-centered planning process with the CCU.
a) The person-centered planning process will
				ensure:
1) the opportunity for the
				participant/authorized representative to lead and direct the planning process,
				whenever possible, and to select other persons to participate in
				decision-making;
2) the scheduling
				of timely meetings that occur at times and locations convenient to the
				participant/authorized representative, preferably in the participant's place of
				residence to assess the participant's environment to ensure the development of
				a person-centered plan of care that considers the participant's
				safety;
3) the provision of
				necessary information and support to enable the participant/authorized
				representative to make informed choices and decisions;
4) the inclusion of strategies for solving
				disagreements within the planning process, including clear guidelines for
				conflicts of interest on the part of all who participate in
				decision-making;
5) the protection
				of the rights of the participant/authorized representative to choose available
				services, supports and providers/vendors; and
6) the sharing of contact information for the
				CCU/Care Coordinator so the participant/authorized representative can request a
				redetermination of eligibility, additional or new services, or other updates
				and changes to the person-centered plan of care.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.600 - Eligibility Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
For purposes of being determined eligible to receive
				  Community Care Program services, requirements of eligibility specified in
				  Sections
				  240.710
				  through
				  240.875
				  must be satisfied.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.610 - Establishing Initial Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Once a participant/authorized representative has contacted the CCU,
				establishing initial eligibility is the joint responsibility of the
				participant/authorized representative and the CCU.
b) It is the responsibility of the
				participant/authorized representative to provide the factual information
				necessary to establish eligibility. Should the participant/authorized
				representative be unable to do so, CCU staff, with the consent of the
				participant/authorized representative, shall assist in obtaining this
				information.
c) If the
				participant/authorized representative refuses to give consent, and information
				needed for eligibility determination is, therefore, unavailable, the request
				for services shall be denied.
d) If
				a home visit, as required by Section
				240.620,
				is made at the address provided by the participant/authorized representative
				and the participant cannot be located, the request for services shall be
				denied.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 240 - COMMUNITY CARE PROGRAM › Subpart F - ELIGIBILITY FOR COMMUNITY CARE PROGRAM SERVICES › Section 240.620 - Home Visit

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				Determinations and redeterminations of need for CCP services shall be
				administered during a visit to the home of the participant, except when
				conducted in the prescreening process or when a CCP participant has been
				hospitalized or placed in any type of institution and will be discharged to the
				community in less than 60 calendar days.
b) A home visit shall be conducted, and a
				redetermination of need administered in the participant's home, within 15
				calendar days after a participant's discharge from a hospital or other
				institution.
c) A home visit shall
				not be required in the conduct of determinations or redeterminations of need
				following hospitalization for routine procedures, as defined in Section
				240.160.