Section 240.920  Reasons for Denial

Denial of CCP eligibility shall be based upon one or more of the reasons identified in this Section:

a)         Participant is less than 60 years of age at the time of the determination of eligibility.

b)         Participant is not in need of CCP services:  scored less than 29 total points/less than 15 points on Part A, Level of Impairment, of the DON.

c)         Participant/legal guardian/authorized representative refuses to sign the Participant Agreement – Person-Centered Plan of Care.

d)         Participant/authorized representative does not agree with the person-centered plan of care/hours of service and an agreement could not be reached during the person-centered planning process.

e)         Participant is deceased.

f)         Participant has been institutionalized or is not otherwise available for services for more than 60 calendar days after the date of referral.

g)         Participant/authorized representative voluntarily withdraws a request.

h)         Participant cannot be located to determine eligibility for or to provide CCP services.

i)          Participant/authorized representative has not provided reasonable documentation supporting eligibility as required by the Department or its CCU within 90 calendar days after the date of receipt of referral.

j)          Participant/authorized representative has not cooperated with the Department/CCU/provider.

k)         Participant does not meet citizenship requirements.

l)          Participant does not meet residency requirements.

m)        The CCU determines that an adequate person-centered plan of care cannot be developed that adequately meets the participant's determined needs under Section 240.715.

n)         The total value of participant's non-exempt assets is in excess of $17,500.

o)         Eligibility could not be established for a participant who was receiving interim services based upon presumptive eligibility.

p)         Participant/authorized representative provided fraudulent information.

q)         A participant whose request for CCP services was previously denied or whose services were terminated for non-cooperation as set forth in Section 240.350 or 240.255 shall be denied services upon a subsequent request for services, unless the situation or condition that led to MOU has been permanently resolved.  In this instance, a CCU must conduct a reassessment of the participant's circumstances to determine whether the situation or condition that led to an MOU has been permanently resolved.

r)          Participant/authorized representative refuses to sign the Participant Agreement and Consent Form.

s)         Participant/authorized representative has transferred non-exempt assets or failed to report a transfer within the past 60 months for the purpose of obtaining CCP services.

t)          Participant/authorized representative has not reported or refused to provide documentation of changes in circumstances that have occurred prior to eligibility determination.

u)         Participant/authorized representative refuses to apply for and, if eligible, enroll in medical assistance under Article V of the Illinois Public Aid Code.

(Source:  Amended at 48 Ill. Reg. 11053, effective July 16, 2024)