Section 146.280  Termination or Suspension of SLF Provider Agreement

a)         The Department may terminate or suspend or not renew the provider agreement subject to the provisions of 89 Ill. Adm. Code 140.16.

b)         In the event that an SLF is found to be out of compliance with certification requirements during an on-site certification review or complaint investigation, the following procedure shall be used:

1)         The Department shall mail a written notice to the SLF within ten days after the conclusion of the on-site review giving the SLF 30 days to correct the non-compliance issue or issues unless the non-compliance involves immediate jeopardy to the health and safety of residents.

2)         For non-compliance involving immediate jeopardy, the Department shall provide a written notice to the SLF within five days after the conclusion of the on-site review giving the SLF ten days to correct the non-compliance issue or issues. The immediate jeopardy must be corrected within ten days after the date of receipt of the notice.  No extension of the ten day period shall be granted.

3)         The SLF shall mail a written notice to the Department within 30 days after the date of the Departmental notice of non-compliance notifying the Department that the non-compliance issue or issues are corrected or requesting an extension of the 30 day period to a specific date with any explanation or documentation necessary to justify the extension.

4)         The Department shall mail a written decision to the SLF within ten days after receipt of the request to extend the 30 day correction period.

5)         The Department shall conduct the first follow-up review within ten days after the conclusion of the ten day immediate jeopardy correction period or within 30 days after the SLF notice date for other non-compliance issues.

6)         In cases of immediate jeopardy, if the first follow-up review continues to show immediate jeopardy, the Department shall take action to suspend or terminate the provider agreement according to 89 Ill. Adm. Code 104.208, Notice of Intent to Terminate, Suspend or Not Renew Provider Agreement.  In cases of immediate jeopardy, where the first follow-up review shows that the immediate jeopardy has been abated, but other non-compliance issues exist, the facility shall be granted a further 30 day period to correct the non-compliance issues.

7)         If the first 30 day follow-up review continues to show non-compliance, the facility shall be granted a second 30 day period to correct the non-compliance issues.

8)         The SLF shall have 30 days to correct any new non-compliance issues cited during a follow-up survey.

9)         The SLF shall be required to submit a written notice identified in subsection (b)(3) of this Section prior to the Department conducting a second or any subsequent follow-up survey.

10)         If the second follow-up review continues to show non-compliance with previously cited issues, the Department shall take action to apply one or more of the following sanctions at the Department's sole discretion, depending on the severity of the non-compliance:

A)        placing a hold on new private pay and Medicaid admissions;

            B)        withholding Medicaid payments;

            C)        suspension or termination of the Medicaid provider agreement; and

D)        directed in-service trainings.

c)         In the event the Department does not impose a sanction to withhold Medicaid payments pursuant to subsection (b)(10)(B) of this Section, the Department will continue to make payments during the pendency of the administrative proceedings set forth in subsection (b) of this Section until a final administrative decision terminating or suspending the provider agreement is issued, for services rendered to Medicaid residents residing in the SLF on the date of the Department's notice sent pursuant to subsection (b)(10) of this Section.  If a final administrative decision terminating or suspending the provider agreement is issued, payments for such services rendered to such persons will cease as of the date the decision is issued, and shall recommence only if and when the SLF is recertified as being in compliance with program requirements.

d)         In the event the Department does not initially impose a hold on private pay and Medicaid admissions pursuant to subsection (b)(10)(A) of this Section, the SLF shall not admit any new residents after receipt of the notice sent pursuant to subsection (b) of this Section.  New admissions may recommence only if and when the SLF has been recertified as being in compliance with program requirements.

(Source:  Amended at 29 Ill. Reg. 4360, effective March 7, 2005)