WAG 01-07-07: Pre-Hearing Meeting

PM 01-07-07

(FCRC) Prepare the Pre-Hearing Meeting Appointment Letter (Form 2491), noting date and time of the pre-hearing meeting and whether it is to be held by phone or in the office. Mail original Form 2491 to appellant. Mail copy of Form 2491 to appellant's representative if they have one. File copy of Form 2491 in case record.

(FCRC) Meet with appellant (and/or their representative).

(FCRC) Explain basis for action being appealed.

(Appellant) Presents any additional information pertaining to action being appealed.

(FCRC) Based upon information presented during the meeting, decide if it's appropriate to reverse, modify, or leave unchanged the appealed action. If a client presents the notice and envelope in which the notice was delivered, use the postmark on the envelope as the date of notice if it's later than the date of notice shown on the central notice list.

(FCRC) When the action is to be reversed or modified, authorize the revised benefits and give written notice to the appellant (or representative). Take the necessary action to authorize benefits. Complete a Notice of Benefit Restoration (Form 3363) or the appropriate notice of approval, denial, or reduction.

(FCRC) Ask the appellant to withdraw the appeal (see WAG 01-07-09 ). The withdrawal of the appeal must be in writing.

(FCRC) Complete and distribute the Statement of Facts (Form 102) if the appeal is not withdrawn after the meeting. See NOTE for exception to completion of Form 102. Use Form 102 to describe the facts supporting the Department's action or inaction.

Send the original Form 102 to the appellant and a copy to their representative. The client must receive the Form 102 at least 2 workdays before the appeal hearing. Allow 2 postal days for receipt.

File a copy of Form 102 in the case record.

Give copy of Form 102 to Hearing Officer during hearing.

NOTE: FCRC does not complete Form 102 if the appeal is about:

a prior approval request for medical service or item; or

a decision to restrict client to a primary care provider; or

an Illinois Office of the Comptroller review decision; or

a Bureau of Collections decision to file a lien on real property owned by an AABD medical long term care client; or

a child care decision; or

any other decision made by an entity other than the FCRC.

In these cases, the office responsible for the decision completes and distributes Form 102 or a Decision Summary. They send the FCRC a copy with supporting documents for the case record.