Section 240.655  Frequency of Redeterminations

Redetermination of eligibility for the Community Care Program shall be conducted by the Case Coordination Unit (CCU) at least annually; or whenever requested by the client/authorized representative; or whenever the client may have experienced a change in his/her needs that indicates the need for a redetermination to assure continued eligibility. (Refer to Section 240.630)

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

b)         Redeterminations conducted at the request of the client/authorized representative or whenever the client may have experienced a change in needs shall be accomplished and a decision rendered within 30 calendar days from 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 client's eligibility shall be extended by any delay caused by the client/authorized representative.

1)         Client delay is defined as the number of calendar days a redetermination of eligibility is delayed because of the client's/authorized representative's failure to provide documentation supporting his/her eligibility within 7 calendar days from the date it is verbally requested by the CCU.

2)         In the event that a client's eligibility cannot be determined due to the client's/authorized representative's failure to provide documentation, as specified above, within 30 calendar days from 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 client shall maintain eligibility and services shall continue to be provided throughout the redetermination process unless the client/authorized representative delays the process beyond the additional 60 calendar days specified in subsection (c)(2) above.

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

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

(Source:  Amended at 19 Ill. Reg. 16031, effective November 20, 1995)