The FY 22 budget includes a total of $75 million in American Rescue Plan Act (ARPA) funding for long term care providers. This project is intended to improve patient care and safety in the face of an ongoing catastrophic public health crisis. This new funding for the financial support of workers in long term care facilities comes amidst an enduring threat to nursing facility residents and staff from the COVID pandemic, as the Federal government makes plans to implement a COVID vaccination requirement for nursing facility staff, immediately following the Governor’s issuance of a vaccine mandate for all workers in Illinois health care facilities, and as nursing shortages remain a concern in Illinois and across the country.

Federal Award Identification Number (FAIN): SLFRP4406 Federal awarding agency: U.S. Department of Treasury Sections 602 and 603 of the Social Security Act as added by section 9901 of the American Rescue Plan Act of 2021, Pub. L. No. 117-2 (Mar. 11, 2021) authorizes the Coronavirus State Fiscal Recovery Fund (CSFRF) and Coronavirus Local Fiscal Recovery Fund (CLFRF) respectively (referred to as the Coronavirus State and Local Fiscal Recovery Funds or SLFRF), which provides $350 billion in total funding to Treasury to make payments generally to States.

Uses are outlined in corresponding language in the FY 22 Budget Implementation Act (BIMP; see 305 ILCS 5/5-5.7a(8) Grant Accountability and Transparency Act: 30 ILCS 708/.

Title 44 Section 7000

This project is intended to improve patient care and safety in the face of an ongoing catastrophic public health crisis. The state has designated funds to be used for the financial support of workers in long term care facilities in light of and for the following reasons. There exists an enduring threat to nursing facility residents and staff from the COVID pandemic. The federal government has emerging plans to implement a COVID vaccination requirement for nursing facility staff. The Governor has issued a vaccine mandate for all workers in Illinois health care facilities. There are ongoing nursing shortages exacerbated by the pandemic in Illinois and across the country. To measure performance, Grantor will use five measures: (1) vaccination rates; (2) nurse staffing levels, (3) COVID-19 infection rates, (4) total number of training hours and (5) number of employees included in training programs. Grantor will collect information on measures 1-3 through publicly available data sources published by the federal government and may supplement with information obtained through a data use agreement with the Illinois Department of Public Health. The data source for vaccination rates and COVID-10 infection rates will be COVID-19 Nursing Home Data - Centers for Medicare & Medicaid Services Data (cms.gov). The data source for nurse staffing levels will be the Staffing Data Submission Payroll Based Journal (PBJ) | CMS. Grantor may collect data regarding the total number of training hours and number of employees included in training programs from the Grantees. Grantees will be required to maintain a record of total training hours and employees and may be required to report such data to the Grantor at Grantor’s request. Grantor may request additional information from the Grantee as needed to measure performance. Grantor will notify the Grantee in writing should additional information be required

Yes

Sub Award Agreement-Part Three: Project Specific Terms: Standing and Authority. Section 26.12 of Part ONE notwithstanding, this section shall take precedence over Section 2.1(e). This Grant is being issued based on formulaic funding and the submission of the Uniform Grant Application is not required. Timely Billing Required. Section 26.12 of Part ONE notwithstanding, this section shall take precedence over Section 4.8. Section 4.8 is not applicable to this Grant Agreement as all payments will be made as upfront payments and no payment requests will be submitted by the Grantee. Indirect Cost Rate Submission. Section 26.12 of Part ONE notwithstanding, this section shall take precedence over Section 7.2. Indirect costs are not an allowable use of funds under this Grant Agreement. Non-compliance. Section 16.3 of Part ONE is modified to add the sentence “Such actions may include steps necessary to initiate recoupment which may include offsets of future Medicaid reimbursement payments or other non-related state payments” to read as follows: “If Grantee fails to comply with the U.S. Constitution, applicable statutes, regulations or the terms and conditions of this or any Award, Grantor may impose additional conditions on Grantee, as described in 2 CFR 200.208. If Grantor determines that non-compliance cannot be remedied by imposing additional conditions, Grantor may take one or more of the actions described in 2 CFR 200.339. The Parties shall follow all Grantor policies and procedures regarding non-compliance, including, but not limited to, the procedures set forth in the State of Illinois Grantee Compliance Enforcement System. 44 Ill. Admin. Code 7000.80 and 7000.260. Such actions may include steps necessary to initiate recoupment which may include offsets of future Medicaid reimbursement payments or other non-related state payments.” Required Periodic Financial Reports. Section 26.12 of Part ONE notwithstanding, this section shall take precedence over Section 13.1. Grantee is not required to submit quarterly periodic financial reports. Budget Submission. The Grant Funds awarded pursuant to this Agreement are being issued on a formula basis without an application process. Grantees are required to submit a Budget using the required Grantor template no later than September 30, 2021. Payments may be distributed prior to the submission of the Budget referenced in ARTICLE VI Section 6.1. Receipt of the Budget by HFS does not constitute approval of the spending plan contained therein. Failure to submit a complete Budget to Grantor in a timely manner may result in recoupment of Grant Funds and suspension of future payments. The Grantee shall program Grant Funds in accordance with the terms and conditions of this Agreement and the submitted Budget. The Grantor will reference the Budget during the review of Final Reporting (ARTICLE XIII) as part of the closeout process of this Award. The Grantee will be notified during the closeout process of any funds deemed to be misspent and any subsequent repayment amounts (see Section 16.3 as modified above for non-compliance).

Other;

Skilled nursing facilities actively serving the Medicaid program as prescribed by the Illinois General Assembly

Registration in GATA portal. Entity must be an eligible enrolled Medicaid provider

Formula Grants

Public Safety

Registration in GATA portal. Entity must be an eligible enrolled Medicaid provider

Registration in GATA portal. Entity must be an eligible enrolled Medicaid provider

The Grant Funds awarded pursuant to the project Agreements are being issued on a formula basis without an application process. Grantees are required to submit a Budget using the required Grantor template no later than September 30, 2021. Payments may be distributed prior to the submission of the Budget referenced in ARTICLE VI 6.1 of the project agreement. Receipt of the Budget by HFS does not constitute approval of the spending plan contained therein. Failure to submit a complete Budget to Grantor (HFS) in a timely manner may result in recoupment of Grant Funds and suspension of future payments. The Grantee shall program Grant Funds in accordance with the terms and conditions of their Agreement and the submitted Budget.

The Grant Funds awarded pursuant to the project Agreements are being issued on a formula basis without an application process.

The Grant Funds awarded pursuant to the project Agreements are being issued on a formula basis without an application process.

Grantees are required to submit a Budget using the required Grantor template no later than September 30, 2021.

Grantees are required to submit a Budget using the required Grantor template no later than September 30, 2021.

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N/A

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Uses are outlined in corresponding language in the FY 22 Budget Implementation Act (BIMP; see 305 ILCS 5/5-5.7a(8) The following outlines the formula and accompanying guidelines with which ARPA funds will be distributed to skilled nursing facilities actively serving the Medicaid program as prescribed by the Illinois General Assembly. HFS has established a rate to distribute the $75 million using the latest available staffing data for total nurse hours across the state. Each facility’s share of the $75 million distribution reflects its estimated share of total nursing hours for the most recently available quarter. Staffing levels were based on nursing hours from the federal Payroll Based Journal for 4Q2020, where available. Each facility will receive $4.43 per hour of nursing, at previously-observed nurse staffing levels, for each of the three months included in the $75 million distribution. Nursing facilities are required to spend the monthly percentage of pass-through to front line workers on the following pandemic-related uses: Vaccine bonus(es) paid March 3, 2021 or later Pandemic bonus pay to employees on or after July 1, 2021 (hazard, hero, other temporary wage increases) Temporary benefits such as day care, etc. provided July 1, 2021 or later Signing bonuses for new hires paid out July 1, 2021 or later Nursing facilities may spend the remainder of their distributions on either the above uses or on other financial support for their workers provided on or after March 3, 2021, as outlined in the BIMP: Payment of education expenses to enhance direct care staff recruitment Enhanced and expanded training for nursing facility staff to better achieve patient outcomes, such as training on infection control, proper personal protective equipment, best practices in quality of care, and culturally competent patient communications Additional forms of pandemic-related financial support for the nursing facility workforce (to be specified by the provider)

Sub-award Agreement: ARTICLE XIV PERFORMANCE REPORTING REQUIREMENTS 14.1. Required Periodic Performance Reports. Grantee agrees to submit Performance Reports as requested and in the format required by Grantor. Performance Measures listed in Exhibit E must be reported quarterly, unless otherwise specified in PART TWO, PART THREE or Exhibit G. Unless so specified, the first of such reports shall cover the first three months after the Award begins. If Grantee is not required to report performance quarterly, then Grantee must submit a Performance Report at least annually. Pursuant to 2 CFR 200.208, specific conditions may be imposed requiring Grantee to report more frequently based on the risk assessment or the merit-based review of the application. In such cases, Grantor shall notify Grantee of same in Exhibit G. Pursuant to 2 CFR 200.329 and 44 Ill. Admin. Code 7000.410(b)(2), periodic Performance Reports shall be submitted no later than the due date(s) specified in PART TWO or PART THREE. For certain construction- related Awards, such reports may be exempted as identified in PART TWO or PART THREE. 2 CFR 200.329. Failure to submit such required Performance Reports may cause a delay or suspension of funding. 30 ILCS 705/1 et seq. 14.2. Close-out Performance Reports. Grantee agrees to submit a Close-out Performance Report, in the format required by Grantor, no later than the due date specified in PART TWO or PART THREE following the end of the period of performance or Agreement termination. See 2 CFR 200.344; 44 Ill. Admin. Code 7000.440(b)(1). 14.3. Content of Performance Reports. Pursuant to 2 CFR 200.329(b) and (c), all Performance Reports must relate the financial data and accomplishments to the performance goals and objectives of this Award and also include the following: a comparison of actual accomplishments to the objectives of the award established for the period; where the accomplishments can be quantified, a computation of the cost and demonstration of cost effective practices (e.g., through unit cost data); performance trend data and analysis if required; and reasons why established goals were not met, if appropriate. Appendices may be used to include additional supportive documentation. Additional content and format guidelines for the Performance Reports will be determined by Grantor contingent on the Award’s statutory, regulatory and administrative requirements, and are included in PART TWO or PART THREE of this Agreement Part Two: Grantor Specific terms Ad-hoc Reporting: The Department may request ad-hoc reports and supporting documentation. Final Reporting: The Grantee shall submit a Final Report no later than the due date specified by the Department following the end of the period of performance for this Agreement or Agreement termination, which is March 31, 2022. The format of this Final Report shall follow a format prescribed by the Department Part Three :Project Specific terms Required Periodic Financial Reports. Section 26.12 of Part ONE notwithstanding, this section shall take precedence over Section 13.1. Grantee is not required to submit quarterly periodic financial reports.

Project Sub Agreement : Article XV: Audits. 15.1. Grantee shall be subject to the audit requirements contained in the Single Audit Act Amendments of 1996 (31 USC 7501-7507) and Subpart F of 2 CFR Part 200, and the audit rules and policies set forth by the Governor’s Office of Management and Budget. See 30 ILCS 708/65(c); 44 Ill. Admin. Code 7000.90. 15.2. Consolidated Year-End Financial Reports (CYEFR). All grantees are required to complete and submit a CYEFR through the Grantee Portal. The CYEFR is a required schedule in the Grantee’s audit report if the Grantee is required to complete and submit an audit report as set forth herein. Article XXVII:(c) Audits. (i) Grantee may not use Grant Funds for costs for audits not performed in accordance with 2 CFR 200, Subpart F. Grantee also may be subject to audits as deemed necessary by authorized governmental entities, including Treasury, the GAO, the PRAC the Treasury's OIG and the State of Illinois Auditor General. Per Treasury Guidance, Grantee may be exempt from certain requirements in Article XV, as set forth below. The exception to CYEFR and lower audit thresholds is limited to a grantee that only receives ARPA funding. (ii) Notwithstanding the provisions in ARTICLE XV herein: The financial statement audit thresholds and the requirement to submit a Consolidated Year-End Financial Report set forth in Article XV do not apply to this Award for all Grantees. Further, if Grantee is a "for-profit" entity, the program-specific audit threshold and the requirement for Grantee to submit an annual audit to the Grantor in ARTICLE XV, if applicable, also do not apply. The exception to CYEFR and lower audit thresholds is limited to a grantee that only receives ARPA funding.

Sub-award Agreement: ARTICLE XII MAINTENANCE AND ACCESSIBILITY OF RECORDS; MONITORING 12.1. Records Retention. Grantee shall maintain for three (3) years from the date of submission of the final expenditure report, adequate books, all financial records and, supporting documents, statistical records, and all other records pertinent to this Award, adequate to comply with 2 CFR 200.334, unless a different retention period is specified in 2 CFR 200.334 or 44 Ill. Admin. Code 7000.430(a) and (b). If any litigation, claim or audit is started before the expiration of the retention period, the records must be retained until all litigation, claims or audit exceptions involving the records have been resolved and final action taken. Article XXVII-Recordkeeping Requirements: (i) The CSFRF guidance issued by Treasury requires a longer records retention period than is required by paragraph 12.1 of this Agreement. Therefore, the Grantee is required to maintain, for five (5) years after all funds have been expended or returned to Treasury by the State, adequate books, all financial records and supporting documents, statistical records, and all other records pertinent to this Award. If any litigation, claim or audit is started before the expiration of the retention period, the records must be retained until all litigation, claims or audit exceptions involving the records have been resolved and final action taken. Grantee is responsible for ensuring all contractors and subrecipients, if applicable, adhere to these records retention requirements. (ii) Grantee agrees to provide or make available all records related to this Award to Grantor or to Treasury upon request, and to any authorized oversight body, including, but not limited to, the Government Accountability Office (“GAO”), Treasury’s Office of Inspector General (“OIG”), and the Pandemic Relief Accountability Committee (“PRAC”).

0324-478-65-4400-00-00 GRNT TO ANN & RBRT H LRIE HOSP 0324-478-65-4900-00-00 LONG TERM CARE SERVICES PRGMS 0324-478-65-4900-01-00 SPEC MENTAL HLTH REHAB FACILTS 0324-478-65-4900-02-00 SUPPORT TO ILLINOIS HOSPITALS Total FY22; $75,000,000

FY22; $75,000,000

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Treasury has published an Interim Final Rule (IFR) on the program guidelines in the Federal Register. See 86 FR 26786 (May 17, 2021) 31 CFR Part 35 RIN 1505-AC77 Coronavirus State and Local Fiscal Recovery Funds (Interim Final Rule) Grant Accountability and Transparency Act: 30 ILCS 708/. FY 22 Budget Implementation Act: 305 ILCS 5/5-5.7a (7) and (8). “Coronavirus State and Local Fiscal Recovery Funds Guidance on Recipient Compliance and Reporting Responsibilities”- US Treasury (6/24/21-Version 1.1) US OMB Memorandum M-21-20 and Memorandum M-20-21 Governor’s Office of Management and Budget (GOMB) in their July 8, 2021 “Memorandum: American Rescue Plan, Coronavirus State Fiscal Recovery Fund- Compliance and Reporting”

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Prescott Bloom Building 201 South Grand Avenue, East Springfield, Illinois 62763

HFS.CARES@Illinois.gov

478-00-2484: Coronavirus Relief Fund (CFDA 21.019)

N/A

8/31/2021

FY 2022 : $280,000,000
FY 2023 : $315,000,000