TITLE 59: MENTAL HEALTH
CHAPTER I: DEPARTMENT OF HUMAN SERVICES
PART 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES
SECTION 120.150 ELIGIBILITY DETERMINATION


 

Section 120.150  Eligibility determination

 

a)         The Department of Public Aid shall determine the individual's eligibility for medical assistance under DPA's rules at 89 Ill. Adm. Code 120.

 

b)         The Department shall assign a PASARR agent to all individuals requesting services.  The PASARR agent shall be responsible for compiling information as needed for the determination of eligibility.  The review of eligibility shall include the criteria included in Section 120.140 of this Part.

 

c)         Individuals or guardians shall be given the choice of receiving State-operated developmental center, community ICF/MR or Medicaid home and community-based services.

 

d)         Eligibility for services under this Part  may be denied for the following reasons:

 

1)         An individual fails to meet the eligibility criteria specified in Section 120.140 of this Part.

 

2)         The applicant does not supply needed information to complete the eligibility determination.

 

3)         The individual service/support plan cannot be designed to adequately meet the individual's needs within the service cost limitations.

 

4)         Expenditure of funds for program services will increase the average per capita costs of services as specified in Section 120.80(c) of this Part.

 

e)         A qualified mental retardation professional shall conduct a redetermination of Medicaid home and community-based services waiver program eligibility within 12 months after the last eligibility determination or redetermination.   A redetermination shall also be conducted if, before 12 months have elapsed, there is a change in circumstances affecting eligibility (see Section 120.120(b) of this Part). A redetermination shall include an examination of criteria identified in Section 120.140 of this Part.  A redetermination of the presence of developmental disability is not required.

 

(Source:  Amended at 20 Ill. Reg. 4762, effective March 8, 1996)