Section 240.400  Appeals and Fair Hearings

a)         Any individual who applies for or receives Community Care Program (CCP) services of any kind has the right to appeal a decision, action or inaction of the Department, a Case Coordination Unit (CCU) or a provider.  If the decision, action or inaction is based on automatic, non-discretionary changes in eligibility, rates or benefits required by Federal or State statute or regulation, which adversely affects some or all clients, the appeal will be automatically denied and the individual will not be afforded a hearing.  The applicant/client/authorized representative shall be notified of his/her right to appeal by the CCU at the time the applicant/client/authorized representative is notified of the action taken. The individual shall be given an explanation of the right to appeal at the time of the initial home visit and upon request.  A copy of the rights and responsibilities of a CCP applicant/client (including an explanation of the right to appeal) shall be provided in written format to all applicants/clients/authorized representatives during the initial home visit for determination of eligibility and upon request.

b)         It shall be the responsibility of the applicant/client/authorized representative to advise the Department of his/her intent to appeal.

c)         The effective date of the appeal is the date on which an applicant/client/authorized representative indicates to the Department the intent to appeal either by telephone or in writing.

d)         If the Department is advised of the intent to appeal either by letter or by telephone, the Department shall, within two work days, send to the appellant a Notice of Appeal to Department on Aging form to be completed and signed by the appellant/authorized representative.

e)         The written notice of appeal must be filed with the Department on a Notice of Appeal to Department on Aging form and shall be completed and executed by the appellant/authorized representative and returned to the Department.

f)          The executed Notice of Appeal to Department on Aging form must be submitted to the Department at the following address:

Illinois Department on Aging

Division of Long Term Care

421 East Capitol Ave., #100

Springfield, Illinois  62701-1789

g)         No later than ten work days from the date of receipt of Notice of Appeal to Department on Aging form, the Department shall send written acknowledgment of receipt to the appellant/authorized representative and to all other parties to the appeal.

h)         The written Notice of Appeal to Department on Aging shall include the following:

1)         the name, address and telephone number of the applicant/client filing the appeal, or on whose behalf the appeal is filed; and

2)         the name, address, and telephone number of the authorized representative, if any, filing the appeal on behalf of the applicant/client; and

3)         the specific action being appealed, including the date of notice advising the applicant/client/authorized representative of the action appealed and the effective date of that action; and

4)         the name of the Case Coordination Unit as indicated on the notice of the action being appealed.

i)          Effective April 1, 1992, Case Coordination Units are to provide a copy of any notice of adverse action to any applicant's/client's authorized representative, if the client has earned ten points on the Mini-Mental State Examination (MMSE).  If the authorized representative is a family member residing with the client, the single notice to the client will suffice.

(Source:  Amended at 26 Ill. Reg. 17358, effective November 25, 2002)