Section 110.10  Application For Assistance

a)         An application is a signed request for assistance on a Department of Public Aid ("Department") form which has been completed to the best of the client's knowledge and ability.

b)         The application must contain an original signature or signatures.  If the application does not contain an original signature or signatures, the local office shall return the application to the sender to obtain the original signature or signatures.

c)         The application must be signed by the applicant with the following exceptions:

1)         When a conservator has been appointed for the applicant, the conservator must sign the application.

2)         When the applicant is physically or mentally unable to sign the application, the application may be signed by someone acting responsibly in behalf of the applicant.

3)         When application is made in behalf of a child, the child's caretaker must sign the application.

4)         When the applicant has appointed an authorized representative with the Department. (An authorized representative is a person authorized by the applicant to act on his or her behalf.)

d)         Application for medical assistance may be made in behalf of a deceased person.  In order for payment to be made by the Department for the funeral and burial expenses of the decedent, the completed application must be received in the local office not more than 30 calendar days after the individual's death, excluding the day on which death occurred, unless delay in receipt of the form occurred through no fault of the individual applying.

e)         The applicant may be assisted by the Department and by individuals of the applicant's choice in completing the application.

f)          The date of application shall be the date a completed original application is received by the local office serving the area of the State in which the applicant lives, with one exception:  for applications completed by pregnant women and children under age 18 at a disproportionate share hospital or federally qualified health center, the date the application is signed by the applicant shall be the date of application.

g)         Medical Assistance No Grant - Aid to the Aged, Blind or Disabled (MANG) (AABD)

Application shall be made for residents of facilities operated by the Department of Mental Health and Developmental Disabilities (DMHDD) only when the services received by the residents are being provided in a covered setting.  Covered setting is defined according to the services provided, the age and diagnosis of the patient and the facility certification. The following are covered settings:

1)         Psychiatric Hospital Service

A)        Client Age:  65 and over

i)          Client Diagnosis:  Any

ii)         Facility Certification:  Title XVIII (Medicare)

B)        Client Age:  Under 21 or up to age 22 when services were being received immediately prior to attaining age 21 and the treatment plan includes re-entry into the community

i)          Client Diagnosis:  Mentally Ill

ii)         Facility Certification:  Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)

2)         Medical/Surgical Services

A)        Client Age:  No Restrictions

B)        Client Diagnosis:  No Restrictions

C)        Facility Certification:  Title XVIII (Medicare)

3)         Skilled Nursing Facility (SNF), Intermediate Care Facility (ICF) and Intermediate Care Facility for the Mentally Retarded (ICF-MR) Services

A)        Client Age:  65 and over

i)          Client Diagnosis:  No Restriction

ii)         Facility Certification:  By Department of Public Health for Title XX (Medicaid)

B)        Client Age:  Up to 65

i)          Client Diagnosis:  Mentally Retarded

ii)         Facility Certification:  By Department of Public Health and Title XX (Medicaid)

C)        Client Age:  Under 21

i)          Client Diagnosis:  Mentally Ill ONLY

ii)         Facility Certification:  JCAHO (Does not include ICF-MR)

h)         Eligibility exists only when the DMHDD patient has not been adjudicated incompetent or if there has been an adjudication of incompetency, a conservator has been legally appointed.

i)          Application shall be made for a patient age 21 or over by the patient, conservator or by someone acting responsibly in the patient's behalf.  Application for patients under age 21 shall be made by the patient's parent or parents, legal guardian or conservator.

j)          If the parents are unwilling to apply for assistance, the patient is not eligible.

(Source:  Amended at 20 Ill. Reg. 14834, effective November 1, 1996)