Illinois Department of Human Services
Division of Developmental Disabilities
Information Bulletin
DD.25.009
Purpose:
This information bulletin is to establish and inform waiver recipients, families, waiver providers, and stakeholders about the guidelines for submitting a discharge appeal reconsideration as required by Public Act 103-1042 Sec. 4-801 (also known as Senate Bill 3753), and to outline the reconsideration process that will be implemented effective January 1st, 2025.
Background:
As noted in Rule 120.110, an Individual, parent, guardian, or Individual's representative may appeal a suspension, termination, or reduction of services by the Division of Developmental Disabilities (DDD) or a provider agency. The desire to appeal is communicated to their Independent Service Coordinator (ISC) who is then responsible for gathering supporting documentation from both the family/individual/guardian, and provider, for the DDD Appeal Unit to review and make an Informal Review determination. In cases of appeal denial, the appeal is sent to Healthcare and Family Services (HFS) for an administrative hearing to be scheduled unless the family/individual/guardian withdraws the issue.
Prior to the passage of Public Act 103-1042, providers did not have an additional course of action if the initial discharge appeal was upheld. With the implementation of Public Act 103-1042, beginning January 1, 2025, providers can request a reconsideration and interdisciplinary review by DDD in these situations. This new discharge appeal reconsideration is limited to the initial DDD appeal determination and does not extend to a Department of Healthcare and Family Services administrative hearing ruling. Rule 120.110 will be formally amended at the next opportunity to include this provision.
Process:
For appeals of suspension, termination, or reduction of services, all supporting documentation collected by the ISC during appeal will be provided to all parties with the Informal Review determination. When a suspension, termination, or reduction of services by a waiver provider is appealed and DDD's Appeals Unit upholds the appeal through the Informal Review Process, finding that the individual has the right to continue to receive current services with the current provider, the provider agency has the option to submit a formal request for reconsideration as outlined below:
The request for reconsideration must be received by the DD Director within 10 working days after the date of the Informal Review notice the provider receives, by encrypting and sending the following to dhs.dddappeals@illinois.gov.
The request for reconsideration must contain:
- The written request for reconsideration signed by the provider agency with an explanation of cause and rationale for reconsideration.
- Documentation to support the provider's decision to suspend, terminate, or reduce services and documentation to support the provider's position that the Informal Review determination should be overturned.
Upon receipt of the request for reconsideration the ISC and individual/guardian involved in the appeal shall be notified of the provider's request and provided with any additional documentation that was included to support the request.
The notification of request for reconsideration with the ISC and individual/guardian shall be followed by 10 working days of mutual exchange of documentation from involved parties.
Within 20 working days after the reconsideration request and mutual exchange of documentation indicated above, DDD shall conduct an interdisciplinary reconsideration review and either reverse or confirm the Informal Review determination. Following the review, the Director of the Division of Developmental Disabilities or director's designee shall issue a determination which confirms or overturns the Informal Review determination being reconsidered.
The receipt of the reconsideration request shall stay the decision pending the final determination by the Division or the withdrawal of the reconsideration. Services shall not be suspended, terminated, or reduced until the reconsideration is complete, pursuant to the exceptions described in Rule 120.
If the result of the reconsideration is a reversal of the DDD Appeal Unit's Informal Review which upheld the individual's appeal and the decision now does not support the individual's appeal, DDD shall forward the reconsideration result and all documents to HFS for an administrative hearing per Rule 120.110.
Contact:
For questions regarding the provider right of reconsideration, email dhs.dddappeals@illinois.gov.
Effective Date:
Effective January 1, 2025
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