This Agreement is entered into by and between the Illinois Department of Human Services, hereinafter referred to as "the Department" or as "the Division", with offices located at 319 E. Madison, Springfield, Illinois, 62701 and __________________________________________, a long term care facility subject to licensure as a ICF/DD or a long term care facility for under age 22 (i.e., a SNF/Ped) with offices located at ____________________________________________, and hereinafter referred to as "the facility".
WHEREAS, the facility currently operates an Intermediate Care Facility for Persons with Developmental Disabilities or a long-term care facility for under age 22 (i.e., a SNF/Ped) and,
WHEREAS, the facility and the Department remain committed to ensuring the health, safety and welfare of the residents of the facility; and,
WHEREAS, the facility agrees to adhere to the Certificate of Need rules, application, processes and time frames of the Health Facilities Planning Board (HFPB) and to the licensure and licensed bed rules, application, processes and time frames of the Illinois Department of Public Health (DPH) regarding notification and application to the State of Illinois of a permanent reduction of licensed beds to the agreed number as stated herein; and,
WHEREAS, the facility voluntarily chooses to permanently reduce the number of licensed beds to_0__and to assist the transfer of the currently enrolled residents to appropriate settings;
NOW THEREFORE, in consideration of the terms set forth herein, the parties agree as follows:
- The facility will implement a downsizing with census benchmarks and rate determinations as set forth in Appendix A which is hereby incorporated and made a part of this Agreement.
- The Department will make payments to the facility for care and services provided to Medicaid-eligible residents and will determine the facility's rates for such payments subsequent to the attainment of census benchmarks as set forth in Appendix A. Upon reaching each established benchmark the capital and support component's rates will be enhanced by the multiplication of the base rate in effect at the initiation of the downsizing period (excluding any COLAs applied to the base) by a factor determined by the division of the licensed beds by the attained census benchmark. The program component rate will be based upon the case-mix Inspection of Care (IOC) information of the residents remaining at each benchmark. Rates shall be determined in accordance with the methodology provided for in statute or rule including any subsequent changes to the methodology or to changes in rates as a result of Cost of Living (COLAs) or other rate changes which are appropriated. When the final benchmark as set forth in Appendix A is achieved, the capital, support and program rates will then be based upon the rate methodology and IOC case-mix of the remaining residents as described in Appendix A and applicable rules, statutes, or appropriations.
- During the downsizing period, the facility may not accept any admissions except with the explicit permission of the Department.
- The facility shall provide a letter of written notice to the guardians of, or if legally competent, the legally competent residents of the facility of the plan to downsize or close the facility upon execution of this Agreement by the Facility and the Department. A draft of this letter is to be reviewed and approved by the Division prior to execution of the Agreement. The letter shall inform its recipients of the consumer's right to an informed choice and of the process for choice determination as described in the PAS Manual, Chapter 1000 Presentation and Selection of Service Options, 1000.20 A. through R . Copies of all letters should be forwarded to the Network Facilitator and the Pre-Admission Screening (PAS) agency(ies). The facility is to cooperate in making opportunities for interested providers to inform consumers of their services, and of the opportunity for an individual to move to CILA or another setting and including the opportunity, where applicable, to enable an individual to move closer to family or other natural supports, and including the selection of day services. The letter shall designate the PAS agency as the contact for persons residing in the facility. Division Network Facilitator staff shall be available to assist individuals in resolving issues and in the coordination of CILA rates packets in determining CILA rates.
- The facility must agree to establish a liaison designee to work with the Division staff and to make every effort to ensure immediate notification (within 72 hours) to the Department and to the local medicaid office of all changes in recipient enrollment, eligibility, income, assets, earnings, and other status. The facility must agree to make available to the Department and interested parties such records as necessary to disclose the type and quantity of care provided to specific residents, as well as physicians' reports, need for care, level of functioning, and orders for services. The facility must agree to provide access to resident care records and facility records and policies concerning resident care throughout the downsizing period.
- Upon execution of this Agreement, the facility must notify via certified mail the Health Facilities Planning Board (HFPB) and the Illinois Department of Public Health (DPH), respectively, of its intent to permanently reduce the number of licensed beds through a downsizing plan and must request instructions for complying with all applicable regulations from these bodies. A copy of this letter shall also be sent to the Division.
- The facility agrees that residents will be moved to appropriate settings as required by State and Federal laws and regulations. The Department will be working closely with the residents, guardians, families, PAS, and the facility to ensure appropriate placement. In transferring residents pursuant to the downsizing, the facility will ensure that appropriate notices and safeguards to residents, family, guardians, etc. as required by State and Federal laws and regulations are initiated and prepared.
- The facility will ensure that the settings to which its residents are transferred are licensed, and/or certified, and/or approved as applicable for that type of setting.
- The facility certifies that none of its officers or employees have been convicted of or admitted to bribery or attempted bribery of any State officer or employee.
- Pursuant to the Civil Rights Act of 1964 and the Rehabilitation Act of 1973, the facility agrees that it will provide services equally to all persons without regard to race, religion, sex, national origin or handicap.bn
- This Agreement terminates ___________. Extensions of this date or amendments to this Agreement may be made by mutual written consent of both parties. The facility agrees that non-compliance with the reduction in the number of licensed beds under this Agreement by the termination date will require the facility to seek approval of an application to the Department of Public Health to permanently establish the number of licensed beds at the level of the census as of midnight of the termination date and to refrain from taking any future actions which would increase the number of licensed beds in the facility.
- The facility assures that it will provide active treatment as provided under Federal and State laws. In the event that the facility fails to comply with licensure or certification requirements, movement of individuals and adjustment of rates will continue. In the event of events or legal proceedings which close the facility in a manner other than through this Agreement, this Agreement shall be terminated on the date or effective date of such events or proceedings.
- The facility agrees that the Department may withhold all payments to the facility after the next to final benchmark in Appendix A is achieved in order to provide a source of funds toward satisfaction of any outstanding obligations owed to the State of Illinois by the facility. The Department agrees to release payments for services provided during the downsizing period and that are owed to the facility not later than 180 calendar days following the attainment of the final benchmark in the Appendix A. Notwithstanding anything to the contrary, the facility agrees to make payment in full for any outstanding indebtedness to the State of Illinois which is not satisfied by this provision of the Agreement from any and all funds of the facility, or its corporate management, ownership, or other related entity.
- The facility affirms that it has the authority to enter into this Agreement and that this Agreement is binding on any and all parties having any ownership or interest in the facility and including the operator, licensee, board(s), trust(s) or trustees, managers or management teams, limited liability corporations, or other corporations, and upon any and all parties having any ownership or interest in the facility, its license, or its premises, physical structure, or real estate.
- In the event the facility or its operations are sold, leased, relocated, transferred, or discontinued, this Agreement shall be binding upon all successor(s) party(ies) and shall be fully disclosed to all parties involved.
- The undersigned representatives of the Department and the facility assert that they have the authority on behalf of the parties to enter into and bind the parties to this Agreement.
WHEREFORE, the parties hereby execute this Agreement effective with the date of signature by the Department.
WHEREFORE, the parties hereby execute this Agreement.
THE FACILITY
____________________________________________ DATE
ILLINOIS DEPARTMENT OF HUMAN SERVICES
____________________________________________ DATE
Director, Division of Developmental Disabilities
