Section 240.400  Appeals and Fair Hearings

a)         Any participant who requests or receives CCP services of any kind has the right to appeal a decision, action or inaction of the Department, a 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, that adversely affect some or all participants, the appeal will be automatically denied and the participant will not be afforded a hearing.  The participant/authorized representative shall be informed by the CCU of his/her right to appeal at the time the participant/authorized representative is notified of the action taken. The participant shall be given an explanation of the right to appeal at the time of the initial home visit at which the action is taken and upon request.  A copy of the rights and responsibilities of participants who request services under  CCP and an explanation of the right to appeal shall be provided in written format during the initial home visit for determination of eligibility and upon request.

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

c)         The effective date of the appeal is the date a participant/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 2 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 its main office in Springfield.

g)         No later than 10 work days after 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 participant  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 participant;

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

4)         the name of the CCU, as indicated on the notice of the action being appealed.

i)          CCUs are to provide a copy of any notice of adverse action to any participant's authorized representative, if the participant has earned 10 points on the Mini-Mental State Examination (MMSE).  A single notice to a residence will suffice if the authorized representative is a family member living with the appellant.

(Source:  Amended at 42 Ill. Reg. 20653, effective January 1, 2019)