Section 148.390 Hearings

Section 148

TITLE 89: SOCIAL SERVICES

CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES

SUBCHAPTER d: MEDICAL PROGRAMS

PART 148 HOSPITAL SERVICES

SECTION 148.390 HEARINGS

Section 148.390  Hearings

Effective for dates of service

on or after July 1, 2014:

a)         The Department may initiate administrative proceedings

pursuant to 89 Ill. Adm. Code 104.Subpart C to suspend or terminate

certification and eligibility to participate in the Illinois Medical Assistance

Program where the provider:

1)         Has failed to comply with 77 Ill. Adm. Code 2090.40;

2)         Does

not have a valid license for an enrolled treatment service category;

3)         Any of the grounds for payment recovery or termination set

forth in 89 Ill. Adm. Code 140.15 or 140.16 or 89 Ill. Adm. Code 104.Subpart C

are present.

b)         When a proceeding is initiated against providers of alcoholism

or substance abuse services, the Department shall notify the provider of the

intended actions.  Notice, service and proof of service shall be in accordance

with the "Rules of Practice For Medical Vendor Administrative

Proceedings" (89 Ill. Adm. Code 104.Subpart C).

c)         All hearings held pursuant to these rules shall be conducted

by an attorney designated by the Director of the Department as a hearing

officer and said hearing shall be conducted under and governed by the

applicable "Rules of Practice For Medical Vendor Administrative

Proceedings" promulgated by the Department (89 Ill. Adm. Code 104.Subpart

C).

d)         The hearing officer shall prepare a written report of the case

which shall contain findings of fact and recommended decisions with regard to

the issues of recoupment, certification and continued participation in the

Medicaid Program.  The Director of the Division of Alcoholism and Substance

Abuse (Department of Human Services) may also make a recommendation in writing

and forward to the Director of the Department

hall prepare a written report of the case

which shall contain findings of fact and recommended decisions with regard to

the issues of recoupment, certification and continued participation in the

Medicaid Program.  The Director of the Division of Alcoholism and Substance

Abuse (Department of Human Services) may also make a recommendation in writing

and forward to the Director of the Department. The Director of the Department

shall then make a final decision based on the findings of fact and all

recommendations.  A final administrative decision shall be issued in writing

and contain findings of fact and the final determinations concerning recoupment,

certification and continued participation in the Medicaid Program.  A copy of

the decision shall be served on each party.