Section 240.415  What May be Appealed

The following actions of CCUs, providers or the Department may be appealed:

a)         A decision to deny, reduce, terminate, or in any way change CCP services or how those services are provided. If the decision to reduce, terminate or in any way change CCP services is based on automatic, non-discretionary changes in eligibility, rates or benefits required by federal or State statute or regulation, which adversely affects some or all participants, the appeal will be automatically denied, and the participant affected will not be afforded a hearing.

b)         A decision to deny a request for redetermination.

c)         Failure to make a decision or take appropriate action on any reasonable request made by a participant within 15 calendar days after the date of the request.

d)         A decision to place a participant on a MOU.

e)         A decision to renew a MOU.

f)         The outcome of the determination of the eligibility for nursing facility level of care or the supportive living program setting.

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