This agreement is entered into by and between the Illinois Department of Human Services, hereinafter referred to as "the Department", with offices located at 319 E. Madison, Springfield, Illinois 62701 and ___________, a long term care facility licensed as an ICF/DD with offices located at ___________________________________ and hereinafter referred to as "the facility".
WHEREAS, the facility currently operates a licensed Intermediate Care Facility for Persons with Developmental Disabilities; 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 process regarding notification to the State of Illinois of a reduction of licensed beds or a discontinuation of a service; and
WHEREAS, the facility voluntarily chooses to reduce the number of licensed beds from ___ to closure and to transfer 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.
- The Department will make payments to the facility for care and services provided to Medicaid-eligible residents in accordance with rates in place at the time of execution of this Agreement. During the downsizing period the facility may not accept any admissions except with explicit written permission of the Department.
- The facility agrees to make every effort to ensure immediate notification (within 72 hours) to the Department and to the Department of Public Aid local office all changes in recipient enrollment, eligibility, income, assets, earnings, and other status. The facility agrees 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 agrees 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 the Illinois Department of Public Health (DPH) of its intent to reduce the number of licensed beds through a downsizing plan and the facility must make timely application to the Department of Public Health (DPH) and the Illinois Health Facilities Planning Board, as applicable, for a formal change to reflect the number of licensed beds pursuant to this Agreement, if any, to remain at the conclusion of the downsizing plan.
- 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 facility to ensure appropriate placement. The facility shall provide a letter of written notice to the guardians of, or if legally competent, the 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 will ensure that the settings to which its residents are transferred are licensed and certified by the Illinois Department of Public Health as required by the Illinois Nursing Home Care Act, or Community Integrated Living Arrangement, Ill. Rev. Stat. ch. 91 1/2 par. 1701 et seq.), and Title XIX of the Social Security Act and its implementing regulations.
- The facility assures that it will provide active treatment as provided under Federal and State laws.
- 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.
- This agreement terminates ____________________. Amendments to this agreement may be made by mutual written consent of both parties.
- The facility agrees to maintain licensure and certification of the facility in compliance with applicable conditions of participation and licensing standards. In the event a facility in compliance with all applicable conditions and standards is notified in writing by the Illinois Department of Public Health of a need for a Plan of Correction for non-compliance with conditions of participation, or Type A violations, or licensure non-compliance, or because it has been declared an "immediate and serious threat" to the welfare of any resident(s), this Agreement shall be suspended as of the date of such notification as follows until such time as the facility returns to full licensure and certification compliance:
Movement of individuals may continue.
Failure by the facility to return to full compliance within any duly stipulated time frames will result in the termination of this Agreement immediately upon the due date specified by the applicable time frame.
- In the event the Department determines that the facility has failed to comply with the terms of this agreement, the Department may withhold payments otherwise due the facility. In the event of any such withholding, the Department will provide the facility with notice of the withholding and an opportunity for an administrative hearing.
- The facility agrees that the Department may withhold all payments to the facility 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 closure. 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 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.
THE FACILITY
____________________________________________ DATE
ILLINOIS DEPARTMENT OF HUMAN SERVICES
____________________________________________ DATE
Director, Division of Developmental Disabilities
