Section 110.1  Incorporation By Reference

 

Any rules or regulations of an agency of the United States or of a nationally recognized organization or association that are incorporated by reference in this Part are incorporated as of the date specified, and do not include any later amendments or editions.

 

(Source:  Added at 13 Ill. Reg. 3836, effective March 10, 1989)

 

Section 110.5  Medical Assistance Application Process

 

An individual will be able to apply for Medical Assistance for himself or herself and/or others, as allowed in this Part, using any of the following methods:

 

a)         Apply by sending an application to an address specified by the Department.

 

b)         Apply at a Department of Human Services (DHS) local office.

 

c)         Apply through an All Kids Application Agent that has an agreement in place with the Department.

 

d)         Effective October 1, 2013, apply online at ABE.Illinois.gov.

 

e)         Apply by telephone by calling a phone number published on the Department's website.

 

f)         Additional methods that the Department may establish.

 

(Source:  Added at 38 Ill. Reg. 5954, effective February 26, 2014)

 

Section 110.10  Application for Medical Assistance

 

The provisions of this Section are effective October 1, 2013.

 

a)         An application is:

 

1)         a signed request for medical assistance in a form approved by the Department of Healthcare and Family Services ("Department") thathas been completed to the best of the client's knowledge and belief;

 

2)         an electronic transmission received from the Social Security Administration on behalf of an applicant for enrollment in the Medicare Savings Program (MSP) and Low-Income Subsidy (LIS) Program pursuant to 42 USC 1320b-14(c). Such a transmission shall be treated as the initiation of an application for MSP benefits as if the application was submitted directly by the applicant;

 

3)         a signed electronically transmitted request for medical assistance in a form approved by the Department, complying with the security requirements of subsection (b)(4), that has been completed to the best of the applicant's knowledge and belief;

 

4)         a signed request for medical assistance submitted by telephone in a form approved by the Department, complying with the security requirements of subsection (b)(4), that has been completed to the best of the applicant's knowledge and belief.

 

b)         The application must comply with the following:

 

1)         Contain the applicant's name and address.

 

A)        A person who is homeless, may use the address of a friend or relative, supervised shelter, church, halfway house, or similar facility.

 

B)        A person who is homeless and does not have a permanent address may use the address of the local Department of Human Services office where he or she applied or where his or her case is currently active.

 

2)         Contain a signature or signatures satisfying one of the following conditions:

 

A)        an original signature or signatures on an application submitted under subsection (a)(1);

 

B)        an electronic signature from the Social Security Administration on an application received under subsection (a)(2);

 

C)        an electronic signature meeting the security requirements of subsection (b)(4) on an application submitted under subsection (a)(3); or

 

D)        a voice recording constituting a telephonic signature meeting the security requirements of subsection (b)(4) on an application submitted under subsection (a)(4).

 

3)         If the application does not contain a name or address, it will not be processed.  If it does not contain a signature or signatures, the Department shall:

 

A)        return an application submitted pursuant to subsection (a)(1) to the applicant to obtain the missing signature;

 

B)        not accept an application submitted pursuant to subsection (a)(2), (a)(3) or (a)(4).

 

4)         Applications submitted pursuant to subsection (a)(3) or (a)(4) of this Section shall:

 

A)        in accordance with Section 25-101(c) of the Electronic Commerce Security Act [5 ILCS 175], meet the security requirements of 14 Ill. Adm. Code 105.210;

 

B)        be captured in a secure format and placed into a secure, auditable database that tracks the user when the application is modified to ensure the integrity, security and confidentiality of the electronic signature; and

 

C)        be made in accordance with the instructions given for completing any form approved by the Department.

 

c)         The application must be signed by the applicant with the following exceptions:

 

1)         When a guardian has been appointed for the applicant, the guardian must sign the application. For purposes of this Section, "guardian" means a representative of a minor or a representative of a person under legal disability as defined in Section 1-2.08 of the Probate Act of 1975 [755 ILCS 5] and a representative as defined in Section 1-2.15 of that Act.  The term "guardian" includes a conservator.

 

2)         When the applicant is physically or mentally unable to sign the application, the application may be signed by someone acting responsibly in behalf of the applicant, including, as allowed by Section 11-4.1 of the Public Aide Code [305 ILCS 5], a representative of a facility licensed under the Nursing Home Care Act [210 ILCS 45] or the ID/DD Community Care Act [210 ILCS 47] or certified under the Public Aid Code.

 

3)         When application is made for a non-emancipated child under the age of 18, the application must be signed by one of the following:

 

A)        the child's caretaker relative with whom the child lives;

 

B)        an individual with whom the child lives who intends to claim the child as a tax dependent; or

 

C)        if neither subsection (c)(3)(A) or (c)(3)(B) applies, the child.

 

4)         When the applicant has appointed an authorized representative with the Department. (An authorized representative is a person authorized by the applicant to act in his or her behalf. The term "approved representative" has the same meaning as the term "authorized representative".)

 

5)         When an electronic application is received from the Social Security Administration as described in subsection (a)(2).

 

6)         When the applicant is a member of a household, as determined pursuant to 89 Ill. Adm. Code 120.64, and another adult member of the household submits application for the applicant.

 

d)         Application for medical assistance may be made in behalf of a deceased person.  In order for payment to be made by the Department for the funeral and burial expenses of the decedent, the completed application must be received in the local office not more than 30 calendar days after the individual's death, excluding the day on which death occurred, unless delay in receipt of the form occurred through no fault of the individual applying.

 

e)         The applicant may be assisted by the Department and by individuals of the applicant's choice in completing the application.

 

f)         The date of application shall be the business day an application with a name, address and proper signature or signatures is received by the Department, with one exception:  for applications completed by pregnant women and children under age 18 at a disproportionate share hospital or federally qualified health center, the date the application is properly signed shall be the date of application.

 

g)         If the Department does not process or does not accept an application for any reason set forth in subsection (b)(3), the Department shall use reasonable efforts to identify the individual who initiated or submitted the application; and inform that individual of:

 

1)         the reason that the Department did not process or did not accept the application; and

 

2)         the action or actions required for an application to be processed or accepted by the Department.

 

(Source:  Amended at 38 Ill. Reg. 5954, effective February 26, 2014)

 

Section 110.15  Consideration of Eligibility

 

Upon receipt of an application for medical assistance, the Department shall consider the applicant's eligibility for all forms of medical assistance, except that the Department shall not consider the applicant's eligibility for any program for which the applicant has indicated, in a written statement, he or she does not want to apply.  A signed application on which the person indicates the program or programs for which he or she does or does not want to apply constitutes the person's written statement.  For purposes of this Section, "medical assistance" means the services and programs reimbursed under the Public Aid Code.

 

(Source:  Amended at 38 Ill. Reg. 5954, effective February 26, 2014)

 

Section 110.20  Time Limitations On the Disposition Of An Application

 

a)         Within 10 days after a decision is made on an application, the Department shall inform the applicant of the decision regarding the applicant's eligibility for medical assistance in a written notice as required by 89 Ill. Adm. Code 102.70. 

 

b)         The Department shall send a written notice, as required by 89 Ill. Adm. Code 102.70, of its determination within the following time periods, calculated from the date of application:

 

1)         Medical assistance for all persons except those seeking to qualify on the basis of having a disability− 45 calendar days;

           

2)         Medical assistance for all persons seeking to qualify on the basis of having a disability  − 60 calendar days.

                         

c)         The time limitation for determining eligibility for any medical assistance shall be tolled for time required by an applicant to obtain information needed to verify eligibility.                 

 

(Source:  Amended at 38 Ill. Reg. 5954, effective February 26, 2014)

 

Section 110.30  Approval of An Application and Initial Authorization of Financial Assistance

 

a)         Financial assistance (for Aid to the Aged, Blind or Disabled, Interim Assistance and Aid to Families with Dependent Children) shall be authorized effective from the earlier of:

 

1)         The date of decision on the current application; or

 

2)         Thirty days after the date of application provided the case is eligible on that date; or

 

b)         Financial assistance for General Assistance shall be authorized effective:

 

1)         Thirty days following the date of application.

 

2)         If General Assistance (GA) is approved as a result of termination of Aid to Families With Dependent Children (AFDC) or Aid to the Aged, Blind or Disabled (AABD) assistance or deletion (AFDC only) for certain non-financial reasons (see 89 Ill. Adm. Code 102.70(f)), assistance shall be authorized with no gap if an application is filed within thirty (30) days of the notice of termination of AFDC or AABD or deletion (AFDC only) (See also 89 Ill. Adm. Code 102.70).

 

c)         If the applicant is determined eligible for financial assistance, the notice (see Section 110.20) shall state the amount of financial assistance to be provided, and a statement of the reasons for any partial grant amounts.  Partial grant amount is defined as the maximum grant that a family unit for whom application for public assistance was filed is eligible to receive, less any reductions resulting from the consideration.

 

(Source:  Amended at 17 Ill. Reg. 640, effective December 31, 1992)

 

Section 110.32  Initial Authorization of Medical Assistance (MAG) (Repealed)

 

(Source:  Repealed at 38 Ill. Reg. 5954, effective February 26, 2014)

 

Section 110.34  Approval of An Application and Initial Authorization of Medical Assistance

 

Authorization of medical assistance shall be effective:

 

a)         The month of application, providing the applicant was eligible in that month; or

 

b)         The month of initial eligibility subsequent to the application date; or

 

c)         A month or months within the 3 months immediately prior to the month of application; provided the applicant meets all eligibility criteria for each month for which medical assistance has been requested.  The months of retroactive medical eligibility may be noncontinuous. Retroactive eligibility does not apply prior to the effective date of the program under which the applicant seeks medical assistance.

 

(Source:  Amended at 38 Ill. Reg. 5954, effective February 26, 2014)

 

Section 110.36  Initial Authorization of General Assistance – Medical (Repealed)

 

(Source:  Repealed at 37 Ill. Reg. 10197, effective June 27, 2013)

 

Section 110.38  General Assistance and Aid to the Medically Indigent Special Approval Provisions (Repealed)

 

(Source:  Repealed at 37 Ill. Reg. 10197, effective June 27, 2013)

 

Section 110.40  Denial of An Application

 

a)         An application for medical assistance shall be denied if it is established that the applicant does not meet one or more of the eligibility requirements or if the applicant chooses to withdraw the application.

           

b)         An application for medical assistance shall be denied if eligibility cannot be conclusively determined because of the applicant's unwillingness to cooperate in providing essential information or refusal to consent to verification, or the applicant has not provided sufficient information for a determination of eligibility.

 

c)         If an application for medical assistance is denied, the written notice required by 89 Ill. Adm. Code 102.70 and sent within the times specified in Section 110.20 shall include the reason why the application was denied.

 

(Source:  Amended at 38 Ill. Reg. 5954, effective February 26, 2014)