Section 240.655  Redeterminations Process

Redetermination of CCP shall be conducted by the CCU at least annually; whenever requested by the participant/authorized representative; or whenever the participant may have experienced a change in his/her needs that indicates the need for a redetermination to assure continued eligibility (see Section 240.630).

a)         A decision on the redetermination shall be made within 30 calendar days after the date the redetermination process begins, except as extended by the Department.

b)         Redeterminations conducted at the request of the participant/authorized representative or whenever the participant may have experienced a change in needs shall be accomplished and a decision rendered within 30 calendar days after the date of the request for redetermination, except as extended by the Department.

c)         The 30 calendar day time limit for completion of a redetermination of a participant's eligibility shall be extended by any delay caused by the participant/authorized representative.

1)         Participant delay is defined as the number of calendar days a redetermination of eligibility is delayed because of the participant's/authorized representative's failure to provide documentation supporting his/her eligibility or otherwise cooperate as set out in Section 240.350.

2)         In the event that a participant's eligibility cannot be determined due to the participant's/authorized representative's failure to provide documentation within 30 calendar days after the date it is verbally requested by the CCU, the CCU shall extend the time limit for an additional 60 calendar days, after which services shall be terminated if documentation is not provided.

d)         The participant shall maintain eligibility and services shall continue to be provided throughout the redetermination process unless the participant/authorized representative delays the process beyond the additional 60 calendar days specified in subsection (c)(2).

e)         Written notification to the participant/authorized representative shall be made as required by Section 240.945.

f)         Any change in services shall be initiated within 15 calendar days after the date the written notice is mailed to the participant/authorized representative, as required by Section 240.945.

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