Section 240.945  Notification

a)         Any participant whose CCP services are being changed in the following manner shall be advised of the change by written notice:  change of service type; reduced amount of service; or termination.

1)         The written notice shall be sent to a participant/authorized representative by certified mail, return receipt requested, or given personally, in which case the participant/authorized representative is to provide a signed and dated receipt for the notice, except for instances involving automatic, non-discretionary changes in eligibility, rates or benefits required by federal or State statute or regulation. In these instances, regular mail is acceptable. Also, in the event of the death of a participant, regular mail is acceptable for notification purposes.

2)         The notice shall clearly state the reason for the action being taken.

3)         The participant/authorized representative shall be notified of the action being taken no later than 15 calendar days after the date of assessment or redetermination and the action shall be effective no sooner than 15 calendar days after the date of the notice if the action is adverse to the participant (see Section 240.160 for a definition of adverse action). This time frame does not apply to termination as a result of the non-cooperative act specified in Section 240.350(b)(1).

4)         In instances involving an automatic, non-discretionary change in eligibility, rates or benefits required by federal or State statute or regulation, the participant/authorized representative will be notified of the action being taken at least 15 calendar days prior to the implementation by the CCU of the change affecting the participant.  The action will be effective no sooner than 15 calendar days after the date of notice if the action is adverse to the participant.

5)         In the event of a death, the termination shall be effective the date of the participant's death. The form shall be dated and mailed/hand-delivered upon the Department or the CCU being informed of the death.

b)         CCP services may be changed, reduced or terminated at the request of the participant/authorized representative and do not require the 15-calendar day notice period under the following circumstances:

1)         the participant/authorized representative provides the CCU with a signed statement that the change, reduction or termination is at his/her request;

2)         the CCU, participant/authorized representative and provider mutually agree to the initiation of the change, reduction or termination on the agreed upon date (which may be less than the required 15 calendar days after the date of the notice to the participant/authorized representative);

3)         a written notice is provided to the participant/authorized representative (either by certified mail, return receipt requested, or handed to the participant/authorized representative, with a receipt provided by the participant/authorized representative for the notice) prior to the initiation of the change or reduction.  The notice shall indicate the agreed upon effective date;

4)         rights of appeal shall not be denied to a participant/authorized representative who has requested a change or reduction in CCP services; and

5)         the CCU has documented all of the requirements of this subsection (b) and placed the participant's statement in the case record.

c)         When an assessment or reassessment for services requires an increase, or no change in service, the participant/authorized representative shall be notified in writing.  The notice shall be mailed by regular mail to the participant/authorized representative within 15 calendar days after the date of the assessment or reassessment.

d)         A copy of any notification mailed/hand-delivered to a participant/authorized representative shall be mailed/provided to the appropriate provider on the same date it is mailed/hand-delivered to the participant/authorized representative.

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