reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.244 - Burden of Proof

Current through Register Vol. 48, No. 28, July 12, 2024
a) Effective
				July 1, 2012, the burden of proof in hearings conducted pursuant to 89 Ill.
				Adm. Code
				140.14
				shall be on the Department if the application was denied because the vendor
				engaged in activities that constitute grounds for termination or was denied
				pursuant to 89 Ill. Adm. Code
				140.14(c).
				The burden of proof shall be on the applicant if the application was denied
				because of:
1) a determination that a
				previously terminated or barred vendor cannot reasonably be expected to meet
				the requirements of the Department;
2) a determination that, based on the
				activities that served as the basis for terminating or barring a vendor, the
				application should not be approved; or
3) denial of the eligibility of the applicant
				pursuant to 89 Ill. Adm. Code
				140.14(e).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.245 - Witness at Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				hearing officer may administer oaths to witnesses.
b) Both the hearing officer and the parties
				or their representatives may examine witnesses.
c) A party may conduct examination and
				cross-examination which is shown to be necessary to a full and fair disclosure
				of facts bearing upon matters in issue, provided that such examination or cross
				examination does not abuse or harass a witness.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.247 - Cross-Examination

Current through Register Vol. 48, No. 28, July 12, 2024
a) Subject to the
				evidentiary requirements of this Part, a party may conduct cross-examination
				required for a full and fair disclosure of the facts.
b) If the presiding hearing officer
				determines that a witness is hostile or unresponsive, he may authorize the
				examination by the party calling such witness as if under
				cross-examination.
c) Any party may
				call any adverse party as a witness and proceed to examine such adverse party
				as if under cross-examination except that the vendor may only call as an
				adverse witness those representatives of the Department or other Departments
				(including the Illinois Department of Public Health) directly involved in the
				audit, investigation, or survey which served as the basis for the Department's
				action under this Part.
d) Any
				party calling a witness, upon a showing that he called the witness in good
				faith and is surprised by his testimony, may impeach that witness by evidence
				of prior inconsistent statements.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.248 - Disqualification of Hearing Officers

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				A party may move for the disqualification of a Hearing Officer based on bias or
				a conflict of interest. The motion must be in writing and must state specific
				facts establishing that bias or a conflict of interest exists. Adverse rulings
				in pending or prior cases shall not be sufficient to establish bias or conflict
				of interest.
b) A motion for
				disqualification shall be made promptly after the moving party learns the
				identity of the Hearing Office or after learning facts that establish grounds
				for disqualification. The motion shall be presented to the Hearing Officer
				assigned to hear the matter.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.249 - Genetic Testing in Contested Paternity Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) In contested paternity hearings, the
				provisions of Section 11 of the Illinois Parentage Act of 1984 [750 ILCS 45/11 ] shall
				govern the ordering of genetic testing, the admissibility of test results,
				presumptions based on the results and all other issues relating to genetic
				testing. References in Section 11 to "the court" shall be deemed to mean the
				Department Hearing Officer.
b)
				Regardless of whether a demand for a judicial trial has been filed under
				Section
				104.213,
				if a respondent fails to comply with an order to submit to genetic testing, an
				administrative order establishing paternity may be entered against
				him.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.250 - Official Notice

Current through Register Vol. 48, No. 28, July 12, 2024
a) Official
				notice may be taken of:
1) Matters of which
				the Circuit Courts of this State may take judicial notice;
2) Matters in prior administrative hearings
				within and without the agency relating to the vendor or alternate payee or
				individuals associated with the vendor or alternate payee (including findings
				and evidence made in hearings initiated prior to December 30, 1977);
3) Generally recognized technical or
				scientific facts within the agency's specialized knowledge;
4) Generally recognized technical, scientific
				or customary and ordinary procedures and operation without the agency's
				specialized knowledge.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.255 - Computer Generated Documents

Current through Register Vol. 48, No. 28, July 12, 2024
Unless proven otherwise, computer generated documents
				  prepared by the Department shall be presumed to constitute an accurate
				  reflection of the Department records as to the amount and type of payment made
				  to the vendor as well as the basis for such payment.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.260 - Recommendation of Peer Review Committee

Current through Register Vol. 48, No. 28, July 12, 2024
a) Whenever an action or decision by the
				Department pursuant to 89 Ill. Adm. Code
				140.14
				through
				140.19
				is based in whole or in part on a report, opinion or recommendation of a
				committee consisting of the vendor's professional peers,
1) A transcript of the vendor's appearance
				before a committee of his peers may be considered and introduced into evidence
				at the hearing; and/or
2) In
				addition to or in lieu of the transcript, a member of the committee may testify
				as to the reports, opinions and recommendations of the committee.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.270 - Time Limits for Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) Hearings
				conducted pursuant to 89 Ill. Adm. Code
				140.14
				and
				140.16
				shall be scheduled within 60 calendar days after service of the notice under
				Sections
				104.204
				or
				104.208(a) and
				(b).
b) Hearings conducted pursuant to 89 Ill.
				Adm. Code
				140.15
				shall be scheduled within 30 calendar days after the completion of the formal
				conference sessions.
c) Hearings
				conducted as the result of an action taken pursuant to Section
				104.300 shall be
				scheduled to take place within 30 calendar days after receipt of a request for
				hearing in accordance with Section
				104.208(c) or
				(d).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.271 - Continuances and Extensions

Current through Register Vol. 48, No. 28, July 12, 2024
A party may be granted one continuance on request. Any other
				  requests will be granted only for good cause shown.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.272 - Withholding of Payments and Release of Withholds

Current through Register Vol. 48, No. 28, July 12, 2024
a) Effective July 1, 2012, payments to any
				vendor or alternate payee on pending and subsequently submitted bills may be
				withheld prior to or during the pendency of any audit, administrative appeal or
				administrative review proceeding by any court:
1) In which:
A) the administrative proceeding seeks the
				termination, exclusion or suspension of the provider or revocation of the
				alternate payee; or
B) the
				administrative hearing is seeking recovery of money and the recovery is at risk
				due to the financial or other circumstances of the provider or the alternate
				payee.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.273 - Continuation of Payments During Pendency of Proceedings

Current through Register Vol. 48, No. 28, July 12, 2024
The Department will continue to make payments during the
				  pendency of an administrative proceeding when federal or State law or
				  regulation does not require such payments to be withheld, and in the following
				  circumstances:
a) If the vendor is a
				nursing home (not an ICF/MR facility), the Department will continue to make
				payments up to the termination date established by the Department for services
				rendered to persons continuously eligible for and receiving Medical Assistance
				and residing in the home on the date of the Department's notice initiating the
				administrative proceeding; or
b) If
				the vendor is an ICF/MR facility, the Department will continue to make payments
				for services rendered to persons continuously eligible for and receiving
				Medical Assistance and residing in the home on the date of the Department's
				notice initiating the administrative proceeding; or
c) If the vendor is a hospital and the
				Department's notice:
1) is a result of
				Medicare action, the Department will continue to make payments for services
				rendered, to persons who are eligible for and receiving Medical Assistance on
				the date of service of the Department's notice, up to the date the vendor's
				participation is terminated; or
2)
				is for Medicaid only action, the Department may withhold payments pursuant to
				Section
				104.272;
				or
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.274 - Denial of Payments for Services During Pendency of Proceedings

Current through Register Vol. 48, No. 28, July 12, 2024
If the vendor is terminated, suspended or excluded, or the
				  alternate payee is revoked, as a result of final agency action, payments or
				  credit for any services rendered subsequent to receipt of the notice of intent
				  to terminate, suspend, exclude or revoke shall be denied unless:
a) Pursuant to Section
				104.273,
				payments were not withheld; or
b)
				Pursuant to Section
				104.272,
				previously withheld payments for such services had been released.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.280 - Record of Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
				complete record of the hearing shall include:
1) all pleadings (including all notices and
				responses thereto, motions and rulings);
2) documentary evidence received;
3) offers of proof, objections and rulings
				thereon;
4) proposed findings and
				exceptions;
5) the recommended
				decision of the hearing officer; and
6) any ex parte communication prohibited by
				Section 10-60 of the Illinois Administrative Procedure Act (Ill. Rev. Stat.
				1991, ch. 127, par. 1010-60).
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.285 - Failure to Appear or Proceed

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				If the vendor or alternate payee, without good cause, fails to appear at a
				hearing or formal conference scheduled by the Department, or fails to proceed
				at a hearing, the Department's action or decision and the grounds asserted as
				the basis therefor shall be a final and binding administrative
				determination.
b) If the Department
				fails, without good cause, to appear at the hearing or formal conference, or
				fails to proceed at a hearing, the Department's action shall be
				dismissed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.290 - Recommended Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) After
				the close of a hearing, the hearing officer shall prepare a written recommended
				decision which shall be based upon the evidence adduced at the hearing or
				otherwise included in the record. The recommended decision shall contain
				findings of fact and recommendations.
b) This recommended decision shall be
				submitted to the Director. The hearing officer shall also send a copy of the
				recommended decision to the Respondent or his counsel and to the Department's
				counsel. Both Respondent and the Department's counsel may file written
				exceptions with the Director within 10 days of receipt. Both Respondent and the
				Department's counsel may file a written response to the exceptions with the
				Director within 5 days of receipt of the exceptions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.295 - Director's Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				Director shall make a final decision in each case. The decision shall be in
				writing and contain findings of fact, and a final administrative decision. A
				copy of the decision shall be served on each party at his last address on file
				with the Department.
b) The final
				decision is reviewable only by a timely complaint filed under the
				Administrative Review Law (Ill. Rev. Stat. 1989, ch. 110, par. 3-101 et seq.).
				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 administrative review.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart D - RULES FOR JOINT DEPARTMENT ACTIONS AGAINST SKILLED NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES PARTICIPATING IN THE MEDICAID PROGRAM › Section 104.300 - Authority

Current through Register Vol. 48, No. 28, July 12, 2024
a) Sections
				104.300 through
				104.330
				are promulgated jointly by the Department of Public Aid and Public Health,
				State of Illinois, pursuant to Section 5-10 of the Administrative Procedure
				Act, Ch. 127, Par. 1005-10 of the Illinois Revised Statutes; Ch. 23, Pars. 5-9,
				12-4.25, 12-4.26, 12-4.27 and 12-13 of the Illinois Revised Statutes; and,
				Federal regulations set forth in
				42 CFR
				431.151.
b) These rules shall govern, except as
				hereinafter stated, the hearing procedures that the State of Illinois must,
				pursuant to
				42 CFR
				431.151, and Chapter 23, paragraph 12-4.25,
				Illinois Revised Statutes, make available to a skilled nursing facility or an
				intermediate care facility when a denial, suspension or termination of the
				eligibility of said facilities to participate as a vendor of goods or services
				to recipients under the Medical Assistance Program is sought as well as prior
				to a denial, termination or refusal to renew certification of said
				facilities.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart D - RULES FOR JOINT DEPARTMENT ACTIONS AGAINST SKILLED NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES PARTICIPATING IN THE MEDICAID PROGRAM › Section 104.302 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
a) For purposes of
				these Rules, IDPH shall mean the Illinois Department of Public
				Health.
b) For purposes of these
				Rules, IDPA shall mean the Illinois Department of Public Aid.
c) For purposes of these Rules, SNF shall
				mean Skilled Nursing Facility.
d)
				For purposes of these Rules, ICF shall mean Intermediate Care
				Facility.
Agency Note: Supplements those applicable definitions
					 contained in the current rules of IDPA and
					 IDPH.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart D - RULES FOR JOINT DEPARTMENT ACTIONS AGAINST SKILLED NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES PARTICIPATING IN THE MEDICAID PROGRAM › Section 104.304 - Department Actions Against Nursing Homes Facilities

Current through Register Vol. 48, No. 28, July 12, 2024
a) A single administrative hearing procedure
				for skilled nursing facilities and intermediate care facilities will be
				followed in those cases where:
1) The
				Department of Public Aid is seeking to deny, suspend or terminate the
				facility's participation in the Medical Assistance Program pursuant to 89 Ill.
				Adm. Code
				140.14
				or
				140.16;
				and
2) The Department of Public
				Health, seeks to deny, terminate or refuse to renew the facility's
				certification to participate in the Medicaid Program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart D - RULES FOR JOINT DEPARTMENT ACTIONS AGAINST SKILLED NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES PARTICIPATING IN THE MEDICAID PROGRAM › Section 104.310 - Certification

Current through Register Vol. 48, No. 28, July 12, 2024
a) As a condition
				of execution of a provider agreement or a renewal thereof by IDPA, the ICF or
				SNF must be currently certified by IDPH in accordance with 42 CFR
				442.
b) When IDPH determines that
				an ICF or SNF does not meet the requirements for certification, IDPH shall
				request that the ICF or SNF submit an acceptable written plan of correction,
				pursuant to 42 CFR 442, unless the facility has serious deficiencies which
				affect the health, safety, or welfare of the residents or repeat deficiencies,
				in which case IDPH shall schedule an informal reconsideration (as provided in
				section 8 of IDPH's Rules and Regulations to carry out provisions of Titles
				XVIII and XIX of the Social Security Act relating to Skilled Nursing and
				Intermediate Care Facilities), or notify IDPA.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart D - RULES FOR JOINT DEPARTMENT ACTIONS AGAINST SKILLED NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES PARTICIPATING IN THE MEDICAID PROGRAM › Section 104.320 - Joint Administrative Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
a) When a proceeding is initiated under these
				rules, the Department and IDPH, jointly, shall notify the ICF or SNF of the
				intended action(s) and of the right to an administrative hearing, by serving a
				"Notice of Intent to Terminate (and Not Certify) and Right to Hearing". Notice,
				service and proof of service shall be in accordance with the "Rules of Practice
				For Medical Vendor Administrative Proceedings" (Sections
				104.200
				-104.295).
b) All hearings held
				pursuant to these rules shall be conducted by an attorney designated by the
				Director of the Department as a hearing officer and said hearing shall be
				conducted under the governed by the applicable Rules of Practice for Medical
				Vendor Administrative Proceedings promulgated by the Department.
c) The hearing officer shall prepare a
				written report of the case which shall contain findings of fact and recommended
				decisions with regard to the issues of certification and participation in the
				Medicaid program. The Director of IDPH shall make a final determination
				regarding certification, which shall be in writing and forwarded to the
				Director of IDPA. The Director of the Department shall then make a final
				decision concerning participation in the Medicaid program, based on the
				findings of fact, the recommended decision and the final certification
				determination by IDPH. A final administrative decision shall be issued in
				writing and contain findings of fact and the final determinations concerning
				certification and participation in the Medicaid program. A copy of the decision
				shall be served on each party.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart D - RULES FOR JOINT DEPARTMENT ACTIONS AGAINST SKILLED NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES PARTICIPATING IN THE MEDICAID PROGRAM › Section 104.330 - Facilities Certified Under Both Medicare and Medicaid

Current through Register Vol. 48, No. 28, July 12, 2024
a) If a SNF is participating, or seeking to
				participate in both Medicare and Medicaid, and if the basis for denial,
				termination or non-renewal of certification and participation in Medicaid is
				also a basis for the denial, termination or non-renewal of participation in
				Medicare, the Department shall notify the facility that:
1) The facility is entitled to the review
				procedures specified or referred to in 42 CFR 405, Subpart D, in lieu of the
				procedures specified or referred to in these rules; and
2) A final decision entered under the
				Medicare review procedures shall be binding on the issue of certification for
				purposes of Medicaid participation.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.400 - Suspected Intentional Violation of the Program

Current through Register Vol. 48, No. 28, July 12, 2024
If the documentation supports the claim of intentional
				  violation of the program, the Department shall send the individual a notice of
				  suspected intentional violation of the program and of the opportunity to waive
				  the administrative disqualification hearing. Examples of such documentation
				  include statements made by a household member on his application, statements
				  made by a household member and recorded in his case record by the caseworker,
				  and statements made by an employer indicating employment of a household member
				  which conflicts with information on the household member's application. Based
				  upon an evaluation of the facts, the Department may refer cases of suspected
				  intentional violation of the program to a court of appropriate jurisdiction for
				  prosecution (See 89 Ill. Adm. Code
				  121.154
				  ). Factors considered by the Department in its evaluation include the dollar
				  amount at issue, evidence of wilful intent to defraud, and the weight of the
				  evidence.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.410 - Advance Notice of Administrative Disqualification Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
The Department shall provide written notice to a household
				  member suspected of intentional violation of the Food Stamp program at least 30
				  calendar days in advance of the date an administrative disqualification hearing
				  has been scheduled. The notice shall contain:
a) The date, time and place of
				hearing.
b) The charge(s) against
				the household member.
c) A summary
				of the evidence and how and where it can be examined.
d) A warning that the decision will be based
				solely on information provided by the Food Stamp office if the household member
				fails to appear.
e) A statement
				that the household member or representative will have 10 calendar days from the
				date of the hearing to present good cause for failure to appear in order to
				receive a new hearing. (See 89 Ill. Adm. Code
				104.60(e)
				for definition of good cause).
f) A
				warning that a determination of intentional violation of the program will
				result in a 6 month disqualification for the first violation, 12 month
				disqualification for the second violation, and a permanent disqualification for
				the third violation, and a statement of which penalty the Department believes
				is applicable to the case scheduled for hearing.
g) A listing of the household member's
				rights. (See rights set forth in 89 Ill. Adm. Code
				104.22
				).
h) A statement that the hearing
				does not preclude a prosecution for civil or criminal fraud.
i) A statement that the individual can call
				the Food Stamp office to get the name and phone number of someone who can give
				free legal advice.
j) The household
				member is also sent a waiver of right to an Administrative Disqualification
				Hearing pursuant to
				7 C.F.R.
				273.16(f). If the household
				member wishes to waive the right to a hearing, he/she must sign the waiver and
				return it to the Department within 20 calendar days of the date of
				notification.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.420 - Postponement of Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
The household member is entitled to one postponement of up to
				  30 calendar days. If the hearing is postponed, the 90 calendar day time limit
				  for reaching a decision is to be extended for as many days as the hearing is
				  postponed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.430 - Administrative Disqualification Hearing Procedures

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Department is to conduct a hearing,
				arrive at a decision, and notify the household member and local office of the
				decision within 90 calendar days of the date the household member is notified
				in writing of the scheduling of an administrative disqualification
				hearing.
b) The hearing shall be
				conducted by an impartial hearing official.
c) The household has the same rights during
				an administrative disqualification hearing that it has during a fair hearing.
				(See 89 Ill. Adm. Code
				104.22
				).
d) The hearing procedures shall
				be published and made available to any interested party.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.440 - Failure to Appear

Current through Register Vol. 48, No. 28, July 12, 2024
If the household member or representative cannot be located
				  or fails to appear at the scheduled hearing without good cause, the hearing is
				  to be conducted without the household member represented. Even though the
				  household member is not represented, the hearing official is required to
				  consider the evidence and determine if an intentional violation of the program
				  was committed based on clear and convincing evidence. If a determination of
				  intentional violation of the program is made, the member has 10 calendar days
				  from the date of the scheduled hearing to present reasons showing good cause
				  for failure to appear. (See 89 Ill. Adm. Code
				  104.60(e)
				  for definition of good cause.) The hearing officer is to determine if the
				  household member had good cause for not appearing and enter the good cause
				  decision on the record. A new hearing is to be conducted if the good cause
				  decision is in favor of the household member.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.450 - Participation While Awaiting a Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
A pending administrative disqualification hearing is not to
				  affect the individual's or the household's right to be certified and
				  participate in the program. Eligibility and level of benefits are determined in
				  the usual manner while the administrative disqualification hearing is pending.
				  The household member suspected of intentional violation of the program is
				  eligible until a hearing officer rules that the individual committed
				  intentional violation of the program.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.460 - Consolidation of Administrative Disqualification Hearing with Fair Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
A fair hearing and an administrative disqualification hearing
				  may be combined into a single hearing if the factual issues arise out of the
				  same, or related, circumstances and the household received prior notice that
				  the hearings will be combined. If a single hearing is held, the timeliness
				  standards for administrative disqualification hearing, as set out in 89 Ill.
				  Adm. Code 104, Subpart E, Food Stamp Administrative Disqualification Hearings,
				  shall be followed.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.470 - Administrative Disqualification Hearing Decision and Notice of Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) The hearing
				officer shall base the decision on whether there is clear and convincing
				evidence that the household member intentionally violated the
				program.
b) If it is decided that
				the household member intentionally violated the program, he/she is sent a
				notice of the decision of the administrative disqualification hearing. The
				notice includes the decision and the reason for the decision.
c) The Department notifies the household of
				the date the disqualification takes effect and the status of remaining eligible
				household members.
d) If the
				hearing officer finds that the household member did not intentionally violate
				the program, the household member is sent a notice informing him that any
				overissuance received by that household will be collected through an
				unintentional household error claim by the Department.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart E - FOOD STAMP ADMINISTRATIVE DISQUALIFICATION HEARINGS › Section 104.480 - Appeal Procedure

Current through Register Vol. 48, No. 28, July 12, 2024
No further administrative appeal procedure exists after a
				  finding of intentional violation of the program by an administrative
				  disqualification hearing or after a household member signs a waiver of right to
				  an administrative disqualification hearing. A fair hearing decision cannot
				  reverse a disqualification decision. However, a household member is entitled to
				  seek relief in a court having appropriate jurisdiction.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart F - INCOPORATION BY REFERENCE › Section 104.800 - Incorporation By Reference

Current through Register Vol. 48, No. 28, July 12, 2024
Any rules or regulations of an agency of the United States or
				  of a nationally recognized organization or association that are incorporated by
				  reference in this Part are incorporated as of the date specified, and do not
				  include any later amendments or editions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.900 - Unauthorized Use of Medical Assistance

Current through Register Vol. 48, No. 28, July 12, 2024
The Department may seek to recover any and all State and
				  federal monies for which it has improperly and erroneously paid for
				  unauthorized use of medical assistance benefits. The Department may also
				  recover any and all civil penalties authorized by law.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.910 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
As used in this Subpart and 89 Ill. Adm. Code 140.Subpart
				  L:
a) "Knowing" and "knowingly" mean
				that a person, with respect to information:
1) has, or should have, actual knowledge of
				the information;
2) acts in
				deliberate ignorance of the truth or falsity of the information; or
3) acts in reckless disregard of the truth or
				falsity of the information, regardless of whether there is specific proof of
				intent to defraud.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.920 - Applicability

Current through Register Vol. 48, No. 28, July 12, 2024
This Subpart applies to administrative actions brought by the
				  Department to recover State and federal monies improperly and erroneously paid
				  to, or on behalf of, any person who knowingly:
a) uses, acquires, possesses or transfers a
				medical card in any manner not authorized by law or by rules and regulations of
				the Department;
b) aids, abets,
				incites, compels or coerces the use, acquisition, possession or transfer of a
				medical card in any manner not authorized by law or by rules and regulations of
				the Department;
c) alters a medical
				card;
d) uses, acquires, possesses
				or transfers an altered medical card;
e) obtains unauthorized medical benefits with
				or without the use of a medical card; or
f) causes to be presented to the Department a
				claim for unauthorized medical benefits.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.930 - Notice of Intent to Recover Money

Current through Register Vol. 48, No. 28, July 12, 2024
a) Prior to the recovery of any amount paid
				for unauthorized medical benefits allegedly obtained, the recipient of the
				benefits shall be afforded an opportunity for a hearing after written notice of
				the Department's intent to recover money. This notice shall be served
				personally or by certified or registered mail or as otherwise provided by law
				upon the person, or his or her agent appointed to receive service, and shall
				contain:
1) a statement of the time, place
				and nature of the hearing;
2) a
				statement of 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) except when a more
				detailed statement is otherwise provided for by law, a short and plain
				statement of the matters asserted, the consequences of a failure to respond,
				and the official file or other reference number;
5) a statement of the monetary value of the
				benefits at issue;
6) a statement
				that, in addition to any other penalties provided by law, a civil penalty not
				to exceed $2,000 may be imposed for each payment or benefit received;
7) a statement providing that the
				Department's findings may be contested by petitioning the Department for an
				administrative hearing; and
8) the
				names and mailing addresses of the administrative law judge, all parties, and
				all other persons to whom the agency gives notice, unless otherwise
				confidential by law.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.940 - Request for Hearing

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any person
				may request a hearing before an administrative law judge to contest the
				Department's recovery action. All such requests must be received by the
				Department within 30 days after receipt of the Department's notice of intent to
				recover money.
b) A request for a
				hearing must be in writing and must contain a brief statement of the basis upon
				which the Department's recovery action is being challenged.
c) If a request for a hearing is not properly
				received, or is received but later withdrawn, the Department's decision and the
				grounds asserted in the Department's notice of intent to recover money as the
				basis for that decision shall be a final and binding administrative
				determination.
d) If a request for
				a hearing is properly received, the Department will schedule a hearing to take
				place within 30 days after the Department's receipt of the request for a
				hearing. The Department will notify the parties in writing of the date, time
				and place of the hearing.
e) A
				request for a hearing may be withdrawn prior to the hearing. A withdrawal must
				be in writing and signed by the person seeking the withdrawal and/or his or her
				representative. The hearing request may also be withdrawn on the record during
				the hearing.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.950 - Representation

Current through Register Vol. 48, No. 28, July 12, 2024
a) Any person may
				appear and be heard at a hearing requested pursuant to Sections
				104.930(a)(7)
				 and
				104.940
				through an attorney at law authorized to practice in the State of Illinois. An
				individual may also appear and be heard on his or her own behalf.
b) Attorneys or other persons appearing in a
				representative capacity shall file a written notice of appearance identifying
				themselves by name, address, telephone number and party represented.
c) 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
				those standards, the Department may decline to permit the person to appear in
				any proceeding or may exclude that person.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.960 - Conduct of Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
				hearing requested pursuant to Sections
				104.930(a)(7)
				 and
				104.940 shall
				be conducted by an attorney designated by the Director of the Department as an
				administrative law judge.
b) The
				administrative law judge shall inquire fully into the matters at issue and
				shall receive testimony of witnesses and any other evidence relevant and
				material to the issues presented. The administrative law judge shall determine
				the order in which evidence is taken and the procedure at the
				hearing.
c) The hearing shall be
				open to such persons as the administrative law judge deems necessary and proper
				for its orderly and efficient conduct.
d) Any person and/or his or her
				representative shall have the opportunity to:
1) examine the documents and evidence to be
				presented at hearing;
2) present
				evidence and witnesses on his or her behalf;
3) refute testimony or other evidence;
				and
4) cross-examine
				witnesses.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.970 - Recommended Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) After
				the close of a hearing, the administrative law judge shall prepare a written
				recommended decision based upon the evidence adduced at the hearing or
				otherwise included in the record. The recommended decision shall contain
				findings of fact and recommendations. The recommended decision shall be issued
				within 60 days after the closing of the record at hearing.
b) The recommended decision shall be
				submitted to the Director of the Department. The administrative law judge shall
				also send a copy of the recommended decision to all parties or their
				counsel.
c) Any party may file
				written exceptions with the Director of the Department within 10 days after
				receipt of the recommended decision. Any adverse party may file with the
				Director a written response to any such exceptions within 5 days after receipt
				of the exceptions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart G - UNAUTHORIZED USE OF MEDICAL ASSISTANCE › Section 104.980 - Final Administrative Decision

Current through Register Vol. 48, No. 28, July 12, 2024
a) The Director of the Department shall make
				a final administrative decision in each case as soon as practicable. This
				decision shall be in writing and contain findings of fact and a final decision.
				A copy of the final administrative decision shall be served on each party at
				his or her last address on file with the Department.
b) The final administrative decision is
				reviewable only by a timely complaint filed under the Administrative Review Law
				[735 ILCS 5 /Art. III]. No petition or motion for rehearing or reconsideration
				is allowed.
c) The filing of a
				petition or a motion or any correspondence in the nature of a petition or
				motion, or any response by the Department to a petition, motion or
				correspondence will not delay the time for filing a complaint in administrative
				review.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 110 - APPLICATION PROCESS › Section 110.1 - Incorporation By Reference

Current through Register Vol. 48, No. 28, July 12, 2024
Any rules or regulations of an agency of the United States or
				of a nationally recognized organization or association that are incorporated by
				reference in this Part are incorporated as of the date specified, and do not
				include any later amendments or editions.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 110 - APPLICATION PROCESS › Section 110.5 - Medical Assistance Application Process

Current through Register Vol. 48, No. 28, July 12, 2024
An individual will be able to apply for Medical Assistance for
				himself or herself and/or others, as allowed in this Part, using any of the
				following methods:
a) Apply by sending
			 an application to an address specified by the Department.
b) Apply at a Department of Human Services
			 (DHS) local office.
c) Apply
			 through an All Kids Application Agent that has an agreement in place with the
			 Department.
d) Effective October 1,
			 2013, apply online at ABE.Illinois.gov.
e) Apply by telephone by calling a phone
			 number published on the Department's website.
f) Additional methods that the Department may
			 establish.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 110 - APPLICATION PROCESS › Section 110.10 - Application for Medical Assistance

Current through Register Vol. 48, No. 28, July 12, 2024
The provisions of this Section are effective October 1,
				2013.
a) An application is:
1) a signed request for medical assistance in
			 a form approved by the Department of Healthcare and Family Services
			 ("Department") thathas been completed to the best of the client's knowledge and
			 belief;
2) an electronic
			 transmission received from the Social Security Administration on behalf of an
			 applicant for enrollment in the Medicare Savings Program (MSP) and Low-Income
			 Subsidy (LIS) Program pursuant to
			 42 USC
			 1320 b - 14(c). Such a transmission shall be
			 treated as the initiation of an application for MSP benefits as if the
			 application was submitted directly by the applicant;
3) a signed electronically transmitted
			 request for medical assistance in a form approved by the Department, complying
			 with the security requirements of subsection (b)(4), that has been completed to
			 the best of the applicant's knowledge and belief;
4) a signed request for medical assistance
			 submitted by telephone in a form approved by the Department, complying with the
			 security requirements of subsection (b)(4), that has been completed to the best
			 of the applicant's knowledge and belief.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 110 - APPLICATION PROCESS › Section 110.15 - Consideration of Eligibility

Current through Register Vol. 48, No. 28, July 12, 2024
Upon receipt of an application for medical assistance, the
				Department shall consider the applicant's eligibility for all forms of medical
				assistance, except that the Department shall not consider the applicant's
				eligibility for any program for which the applicant has indicated, in a written
				statement, he or she does not want to apply. A signed application on which the
				person indicates the program or programs for which he or she does or does not
				want to apply constitutes the person's written statement. For purposes of this
				Section, "medical assistance" means the services and programs reimbursed under
				the Public Aid Code.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 110 - APPLICATION PROCESS › Section 110.20 - Time Limitations On the Disposition Of An Application

Current through Register Vol. 48, No. 28, July 12, 2024
a) Within 10 days
			 after a decision is made on an application, the Department shall inform the
			 applicant of the decision regarding the applicant's eligibility for medical
			 assistance in a written notice as required by 89 Ill. Adm. Code
			 102.70.
b) The Department shall send a written
			 notice, as required by 89 Ill. Adm. Code 102.70, of its determination within
			 the following time periods, calculated from the date of application:
1) Medical assistance for all persons except
			 those seeking to qualify on the basis of having a disability- 45 calendar
			 days;
2) Medical assistance for all
			 persons seeking to qualify on the basis of having a disability - 60 calendar
			 days.
Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 110 - APPLICATION PROCESS › Section 110.30 - Approval of An Application and Initial Authorization of Financial Assistance

Current through Register Vol. 48, No. 28, July 12, 2024
a) Financial
			 assistance (for Aid to the Aged, Blind or Disabled, Interim Assistance and Aid
			 to Families with Dependent Children) shall be authorized effective from the
			 earlier of:
1) The date of decision on the
			 current application; or
2) Thirty
			 days after the date of application provided the case is eligible on that date;
			 or