Section 120.308 Client Cooperation

Section 120

TITLE 89: SOCIAL SERVICES

CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SUBCHAPTER b: ASSISTANCE PROGRAMS

PART 120 MEDICAL ASSISTANCE PROGRAMS

SECTION 120.308 CLIENT COOPERATION

Section 120.308  Client

Cooperation

a)         As a condition of

eligibility, clients must cooperate:

1)         in the

determination of eligibility; and

2)         with

Department programs conducted for the purposes of acquisition or verification

of information upon which eligibility may depend.

b)         Clients are required to avail themselves of all potential income

and resources and to take appropriate action to receive such resources, including

those described under Section 120.388(d)(2).

c)         When eligibility cannot be conclusively determined because the

individual is unwilling or fails to provide essential information or to consent

to verification, the client is ineligible.

d)         At screening, applicants shall be informed, in writing, of any

information they are to provide at the eligibility interview.

e)         At the eligibility interview or at any time during the

application process, when the applicant is requested to provide information in the

applicant's possession, the Department will allow 10 days for the return of the

requested information.  The first day of the 10 day period is the calendar day

following the date the information request form is sent or given to the

applicant.  The last day of the 10 day period shall be a work day and is to be

indicated on the information request form.  If the applicant does not provide

the information by the date on the information request form, the application

shall be denied on the following work day.

f)         At the eligibility interview or at any time during the

application process, when the applicant is requested to provide third party

information, the Department shall allow 10 calendar days for the return of the

requested information or for verification that the third party information has

been requested

rmation request form, the application

shall be denied on the following work day.

f)         At the eligibility interview or at any time during the

application process, when the applicant is requested to provide third party

information, the Department shall allow 10 calendar days for the return of the

requested information or for verification that the third party information has

been requested. The first day of the 10 day period is the calendar day

following the date the information request form is sent or given to the

applicant.  The last day of the 10 day period shall be a work day and will be

indicated on the information request form. If the applicant does not provide

the information or verification that the information was requested by the date

on the information request form, the application shall be denied on the

following work day.

1)         Third party information is defined as information that must be

provided by someone other than the applicant.  An authorized representative or

person applying on another's behalf is not a third party, but is treated as if

he or she were the applicant.

2)         The Department shall advise clients of the need to provide

written verification of third party information requests and the consequences

of failing to provide that verification.

3)         If the applicant requests an extension either verbally or in

writing in order to obtain third party information and provides written

verification of the request for the third party information, such as a copy of

the request that was sent to the third party, an extension of 45 days from the

date of application shall be granted. The first day of the 45 day period is the

calendar day following the date of application. The 45

th

day must be

a work day.

A)        For

long term care (LTC) applicants, the Department shall send a request for

information about current resources or resources transferred in the look-back

period to the applicant or the applicant's approved representative, as

described in 89 Ill

ll be granted. The first day of the 45 day period is the

calendar day following the date of application. The 45

th

day must be

a work day.

A)        For

long term care (LTC) applicants, the Department shall send a request for

information about current resources or resources transferred in the look-back

period to the applicant or the applicant's approved representative, as

described in 89 Ill. Adm. Code 110.10(c)(4), and the facility named on the

application.  The request for information shall include an explanation of the

information required; the date by which it must be submitted; a statement that

failure to respond in a timely manner can result in denial of the application;

a statement that an extension of time may be requested by the applicant or on

behalf of the applicant by the applicant's spouse or approved representative or

the facility in which the applicant lives; and the name and contact information

of a caseworker or another State official in case of questions.

B)        For

LTC applicants, when requested by the applicant, the applicant's spouse, the approved

representative, or the facility in which the applicant lives, the Department

shall allow an extension of up to 30 days to provide verification about current

resources or resources transferred under the look-back period described in

Section 120.387 or 120.388.

C)        When

requested by the applicant, the applicant's spouse, the approved

representative, or the facility in which the applicant lives, the Department

may allow a second 30-day extension if needed.  The Department shall take into

account what is in the best interest of the applicant when deciding whether to

grant a second 30-day extension of time to respond.

D)        An

extension of time to provide information extends the State's processing

timeframes for the same period.

E)        Subsections

in which the applicant lives, the Department

may allow a second 30-day extension if needed.  The Department shall take into

account what is in the best interest of the applicant when deciding whether to

grant a second 30-day extension of time to respond.

D)        An

extension of time to provide information extends the State's processing

timeframes for the same period.

E)        Subsections

(f)(3)(B), (C) and (D) shall be effective June 16, 2014.

4)         If an applicant's attempt to obtain third party information is

unsuccessful, upon the applicant's request, the Department will assist in

securing evidence to support the client's eligibility for assistance.

g)         Any

information or verifications requested under this Section must be returned to

the Department's or its agent's office in the manner indicated on the

information request form.  Information mailed or otherwise delivered to an

address not indicated on the form will not toll the timeframes for providing

information under this Section.

h)         Failure

to cooperate in the determination of eligibility under this Section, including

failure to provide requested information or verifications, is a basis for the

denial of an application for benefits.  A person has the right to appeal such a

denial under 89 Ill. Adm. Code 102.80.  The Department shall not deny an

application if third party information cannot be timely obtained when the delay

is beyond the control of the applicant and a timely request was made to the

third party for the information.  The Department shall not deny an application

for failure to timely provide information in the applicant's possession if the applicant

has made a good faith attempt to retrieve the information and is unable, due to

incapacity, illness, family emergency or other just cause, to do so

lay

is beyond the control of the applicant and a timely request was made to the

third party for the information.  The Department shall not deny an application

for failure to timely provide information in the applicant's possession if the applicant

has made a good faith attempt to retrieve the information and is unable, due to

incapacity, illness, family emergency or other just cause, to do so.

i)          Effective

June 16, 2014, clients and applicants who receive Supplemental Security Income

(SSI) payments or who were receiving SSI when they entered a long-term care

facility or the supported living program or initiated other long term support

services are considered to have their current income verified, unless there is

a specific reason to question the amount of income the individual receives.