Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 02/25/14

New Provider Agreements

​To: ​Intermediate Care Facilities for Individuals with Intellectual Disabilities Only
​Date: ​February 25, 2014
​Re: ​New Provider Agreements

This notice follows up on an April 12, 2013 Elimination of Time Limited Provider Agreement provider notice that informed Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Provider Agreements are no longer time-limited. As a result, a new Provider Agreement must be completed and submitted by each ICF/IID. Once issued the new Provider Agreement will no longer expire as of a specific date and will remain valid unless there is a change of ownership or HFS notifies the facility the agreement is being withdrawn due to adverse federal or state action.

 

ICF/IID and Nursing Facility Provider Agreements have been merged into one Agreement, Form HFS 1432, Long Term Care Provider Agreement (pdf). Each provider will indicate their provider type by marking the appropriate box at the top of the new Provider Agreement.

 

Providers must complete and submit the updated Provider Agreement by close of business February 28, 2014. Completed Provider Agreements should be directed to:

 

Healthcare and Family Services

Bureau of Long Term Care – Certification Unit

201 South Grand Avenue East

Springfield, Illinois 62762-0002

If you have any questions concerning this notice contact the Bureau of Long Term Care at 217-782-0545.

 

 

Theresa A. Eagleson, Administrator

Division of Medical Programs