Section 240.480  The Appeal Decision

a)         The decision resulting from the appeal shall be made in writing no later than 90 calendar days from the close of the hearing record.  The appellant/authorized representative and all other parties to the appeal shall be notified by sending to them a copy of the decision by United States mail. The decision shall be made by applying Department rules to the particular case situation.  Appeals shall be considered on a case by case basis.

b)         The Final Administrative Decision shall be issued by the Director of the Department and it shall either:

1)         uphold or modify the Hearing Officer's recommendation in the appeal;

2)         not uphold the Hearing Officer's recommendation; or

3)         determine a lack of Department jurisdiction.

c)         The decision shall instruct the vendor/Case Coordination Unit (CCU)/Department to take corrective action as appropriate.  In the event that the applicant/client who is a party to the appeal purchased services not provided by the vendor during the period in which the appeal was conducted, the Department will reimburse the applicant/client under the following conditions:

1)         the decision rendered by the Department is in favor of the applicant/client in whose behalf the appeal was taken; and

2)         either:

A)        the appeal was filed based upon the denial of an application; or

B)        the appeal was filed as the result of discontinuance of services due to the failure of the client to make payment of incurred expense for care as assessed in accordance with Sections 240.855 and 240.870 of this Part.

d)         Payment shall be authorized only for the level, type and amount of services for which payment would have been made through the Community Care Program during the same time period.  Payment shall not exceed the amount which would have been paid through the Community Care Program for the same services.

e)         The decision resulting from the appeal and the recorded transcript shall become a part of the record of the appeal.

(Source:  Amended at 23 Ill. Reg. 5642, effective May 1, 1999)