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Elizabeth M. Whitehorn, Director

Provider Notice issued 08/11/2026

Cost Report Update – New Attestation on Hold Harmless Arrangements

To:
 Long Term Care (LTC) Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Medically Complex for the Developmentally Disabled Facilities (MC/DD)
​Re:
 Cost Report Update – New Attestation on Hold Harmless Arrangements
Date:
 August 14, 2026

This notice is to inform Long Term Care providers that the 2026 cost report includes a new attestation on Page 1 Section II, “Certification by Authorized Facility Officer”. The following language has been added as part of the State of Illinois’ oversight of the provider assessment taxes to ensure compliance with federal regulations.

“I attest that the facility does not participate in any hold harmless arrangement for any health care-related tax as specified in § 433.68(f)(3) in which the State or other unit of government imposing the tax provides for any direct or indirect payment, offset, or waiver such that the provision of the payment, offset, or waiver directly or indirectly guarantees to hold the taxpayer harmless for all or any portion of the tax amount.”

Federal hold harmless requirements related to health care-related taxes are described in statute at section 1903(w)(4) of the Social Security Act and federal regulation at 42 CFR § 433.68(f)(3). Specifically, the regulation prohibits any direct or indirect payment, offset, or waiver such that the provision of payment, offset, or waiver directly or indirectly guarantees to hold taxpayers harmless for all or any portion of the tax amount. These hold harmless arrangements would include situations involving the redistribution of Medicaid payments among providers.

If a provider is a party to an arrangement among providers or other entities that involve the redistribution of Medicaid payments, or has questions regarding this notice, please contact the Bureau of Long-Term Care (BLTC) toll free at 844-528-8444.  

 

Laura Phelan
Administrator, Division of Medical Program