Document:

Exhibit 10.50  

PROVIDER PARTICIPATION AGREEMENT

Between

ARIZONA HEALTH CARE

COST CONTAINMENT SYSTEM ADMINISTRATION (AHCCCSA)

and 

	

	Provider Name	 	SSN/Tax ID #                
	 Located at
	

	Business Address	 	City, County, State, Zip Code

This
Agreement between AHCCCSA and the Provider is made pursuant to Title XIX of the Social Security Act and A.R.S. Title 36, Chapter 29 to govern: (1) registration and
payment for the health care services provided by the Provider to eligible persons who are not enrolled with a program contractor or health plan under contract with AHCCCSA
("Contractors") or who receive emergency services ("fee-for-service patients"), and (2) registration for the Provider to participate in the Arizona Health Care
Cost Containment System through a Contractor. 

In
consideration of the covenants contained in this Agreement: 

	I.
	Fee-for-Service
Patients

	1.
	AHCCCSA
agrees to make payments to the Provider, consistent with State and Federal law, the terms of this Agreement, and the AHCCCSA Capped
Fee-For-Service Payment Schedule (including amendments thereto and as hereby incorporated by reference), for the health care services provided by the Provider to
fee-for-service patients.

	2.
	With
respect to fee-for-service patients, the Provider agrees to bill in accordance with the terms of this Agreement, State and Federal law, and the
following documents, including amendments thereto, hereby incorporated by reference: the AHCCCS Fee-For-Service Manuals, the AHCCCS Medical Policy Manual, AHCCCS Claims
Clues and other written directives provided by the AHCCCSA to the Provider. These documents shall be made available to the Provider either in hard copy or via AHCCCS Internet Website at
www.ahcccs.state.az.us. The Provider shall conform its billing practices to ICD9, CPT and HCPCS compliance standards except when those standards conflict with AHCCCS policies defined
listed above.

	3.
	The
Provider agrees to bill the AHCCCSA only after a potential third party payer has been billed and, after payment has been received, to bill AHCCCSA the balance due only up to
the limit of the member's responsibility.

	4.
	In
addition to other remedies available under this Agreement, AHCCCS shall be entitled to offset against any amounts due the Provider any overpayments, expenses or costs
incurred by AHCCCSA concerning the Provider's non-compliance with this Agreement. The rights and remedies of AHCCCSA under this contract are not exclusive.

	5.
	The
Provider shall maintain for the duration of this Agreement policies of professional liability insurance, comprehensive general liability insurance and automobile liability
insurance. The Provider agrees that any insurance protection required by this Agreement, or otherwise obtained by the Provider, shall not limit the responsibility of Provider to
indemnify, hold harmless and defend the State and AHCCCSA, their agents, officers and employees as provided herein. Furthermore, the Provider shall be fully responsible for all taxes, Worker's
Compensation Insurance, and all other applicable insurance coverage, for itself and its employees, and AHCCCSA shall have no responsibility or liability for any such taxes or insurance
coverage. 

	II.
	Participation
through a Program Contractor or Health Plan

	1.
	With
respect to any services furnished by the Provider to an AHCCCS eligible person enrolled with a Contractor, the terms and conditions of payment shall be as set forth in the
contract between the Provider and the Contractor notwithstanding any inconsistent provisions of Section I of this Agreement.

	2.
	The
Provider agrees to hold the AHCCCSA harmless, and agrees not to seek reimbursement from AHCCCSA, for services rendered, pursuant to a contract between the provider and a
Contractor to AHCCCS eligible persons enrolled with a Contractor.

	III.
	General
Terms and Conditions 

        The
following terms and conditions apply both to services provided on a fee-for-service basis and services provided through a Program Contractor or Health
Plan: 

	1.
	Pursuant
to 42 CFR 431.107, Provider is prohibited from participation in the Arizona Health Care Cost Containment System unless a provider agreement with the
Administration is in effect. Provider may not enter into or continue any contracts for the delivery of heatlh care services to any AHCCCS eligible person with any Contractor if this
Agreement is terminated. Furthermore, the AHCCCSA will not pay the Provider for any services rendered if there is no Agreement in effect at the time a claim is submitted.

	2.
	When
AHCCCSA issues an amendment to modify this Agreement or to modify documents incorporated by references as part of this Agreement, the provisions of such amendment will be
deemed to have been accepted 30 days after the date AHCCCSA provides notice to the Provider, even if the amendment has not been signed by the Provider, unless within that time the
Provider notifies AHCCCSA in writing that it refuses to sign the amendment. If the Provider gives such notification, this Agreement terminates.

	3.
	The
Provider shall maintain all records relating to performance of this Agreement in compliance with all specifications for record keeping established by AHCCCSA. All books and
records shall be maintained in such detail as shall reflect each service provided and all other costs and expenses of whatever nature for which payment is made to the Provider. Such
material shall be subject to inspection, audit or copying by the state, AHCCCSA, the U.S. Department of Health and Human Services, any other authorized representative of the state or
federal governments during normal business hours at the Provider's place of business. The Provider shall preserve and make available records for a period of five years from the date of
payment under this Agreement except: (1) if this Agreement is completely or partially terminated, the records relating to the work terminated shall be preserved and made available for a
period of five years from the date of any such termination; and (2) records which relate to disputes, litigation or the settlement of claims arising out of this Agreement, or costs and
expenses of this Agreement to which exception has been taken by the state, shall be retained by the Provider until such disputes, litigation, claims or exceptions have been disposed of. The
Provider shall comply with all applicable AHCCCS Rules and Audit Guide relating to the audit of the Provider's records and the inspection of the Provider's facilities. If the Provider is an
inpatient facility, the Provider shall file uniform reports and Title XVIII and Title XIX cost reports with AHCCCSA.

	4.
	The
Provider, by execution of this Agreement, warrants that it has the ability, authority, skill, expertise and capacity to perform the services specified in this contract. The
Provider shall obtain and maintain all licenses, permits and authority necessary to do business and render service under this Agreement and, where applicable, shall comply with all
laws regarding safety, unemployment insurance, disability insurance and worker's compensation.

	5.
	The
Provider agrees to hold harmless the state, all state officers and employees, AHCCCSA and other appropriate state agencies, and all officers and employees of AHCCCSA against all
injuries, deaths, losses, damages, claims, suits, liabilities, judgments, costs and expenses which may, in any manner, accrue against the State, AHCCCSA or its agents, officers or
employees, or AHCCCS 

contractors,
through the intentional conduct, negligence or omission of the Provider, its agent, officers or employees. 

	6.
	The
Provider shall comply with all federal, State and local laws, rules, regulations, standards and executive orders governing performance of duties under this Agreement, without
limitation to those designated within this Agreement.

	7.
	Confidential
information shall be safeguarded pursuant to 42 CFR Part 431, Subpart F, ARS §36-107,
36-2903, 41-1959 and 46-135, any other applicable State and Federal laws, and AHCCCS and/or ALTCS Rules.

	8.
	Any
grievances filed by the Provider shall be adjudicated in accordance with AHCCCS Rules as published in the Arizona Administrative Code. The Provider agrees to waive
attorneys' fees in any disputes concerning this Agreement.

	9.
	Upon
thirty (30) days written notice, either party may voluntarily terminate this Agreement. AHCCCSA has the right to terminate this Agreement upon
twenty-four (24) hours written notice when AHCCCSA deems the health or welfare of a member is endangered; the Provider fails to comply with Federal and State laws and
regulations; or there is a cancellation, termination or material modification in the Provider's qualifications to provide.

	10.
	AHCCCSA
may, by written notice to the Provider, terminate this Agreement if it is found, after notice and hearing by the State, that gratuities in the form of entertainment,
gifts, or otherwise were offered or given by the Provider, or any agent or representative of the Provider, to any officer or employee of the State with a view towards securing a
contract or securing favorable treatment with respect to the awarding, amending or the making of any determinations with respect to the performance of the Provider; provided, that the
existence of the facts upon which the state makes such findings shall be in issue and may be reviewed in any competent court. If the Agreement is terminated under this section, AHCCCSA
shall be entitled to a penalty, in addition to any other damages to which it may be entitled by law, and to exemplary damages in the amount of three times the cost incurred by the
Provider in providing any such gratuities to any such officer or employee.

	11.
	Upon
termination of this Agreement, the Provider shall assist in providing for the orderly transition of care for recipients assigned to the Provider upon termination of this
Agreement.

	12.
	The
Provider shall comply with State Executive Order 99-4, incorporated by reference as part of this Agreement, and Federal Order 11246 which prohibit
discrimination based on of race, color, religion, sex, age, national origin or political affiliation.

	13.
	By
signing this Agreement, the Provider certifies that it has not engaged in any violation of the Medicare Anti-Kickback statute (42 USC
§§1320a-7b) or the "Stark I" and "Stark II" laws governing related-entity referrals (PL 101-239 and PL 101-432) and compensation
therefrom. If the Provider provides laboratory testing, it certifies that it has complied with 42 CFR §411.361 and has sent to AHCCCSA simultaneous copies of the information
required by that rule to be sent to the Health Care Financing Administration.

	14.
	By
signing this Agreement, the Provider certifies that it complies with the Clinical Laboratory Improvement Amendment (CLIA) of 1988 that requires laboratories and other facilities
that test human specimens to obtain either a CLIA Waiver or CLIA Certificate in order to obtain reimbursement from the Medicare and Medicaid (AHCCCS) programs. In addition, they must
meet all the requirements of 42 CFR 493, Subpart A. AHCCCSA requires all clinical laboratories to provide verification of CLIA Licensure or Certificate of Waiver during the
provider registration process. Failure to do so shall result in either a termination of this Agreement or denial of initial registration. Pass-through billing or
other similar activities with the intent of avoiding the above requirements are prohibited.

	15.
	The
Provider shall not bill, nor attempt to collect payment directly or through a collection agency from a person claiming to be AHCCCS eligible without first receiving
verification from AHCCCSA 

that
the person was ineligible for AHCCCS on the date of service, or that services provided were not AHCCCS covered services. The Provider agrees to abide by Arizona Administrative Code
R9-22-702 prohibiting the Provider from charging, collecting, or attempting to collect payment from an AHCCCS eligible person. 

	16.
	If
the Provider discovers, or is made aware, that an incident of potential fraud or abuse has occurred, the Provider shall report the incident to the Health Plan, Program
Contractor, or the Administration who shall proceed in accordance with the AHCCCS Health Plans and Program Contractors Policy for Prevention, Detection and Reporting of
Fraud and Abuse. Incidents involving potential member eligibility fraud should be reported to AHCCCSA, Office of Managed Care, Member Fraud Unit. All other
incidents of potential fraud should be reported to AHCCCSA, Office of the Director, Office of Program Integrity.

	17.
	The
Provider agrees to submit, within thirty-five (35) days after the date of request by AHCCCSA or the U.S. Department of Health and Human Services, full
and complete information as to ownership, business transactions, and criminal activity in accordance with 42 C.F.R. 455 Subpart B and State law.

	18.
	The
Provider agrees to comply with the advance directive requirements specified in Part 489, Subpart I, and Section 417.436 (d) of the Code of
Federal Regulations. 

	
 FOR AND ON BEHALF OF THE PROVIDER	 	
 FOR AND ON BEHALF OF AHCCCSA
	

Signature                                        
             Date	
 	

 Authorization
	

 Typed Name	
 	

 Date
	

 Title	
 	

 Provider Number AssignedExhibit 10.51  

	STATE OF TEXAS	 	§
	 	 	§
	COUNTY OF [COUNTY]	 	§

CONTRACT TO PROVIDE

NURSING FACILITY SERVICES

UNDER THE

TEXAS MEDICAL ASSISTANCE PROGRAM  

(Name
of Facility) 

(Street
Address) 

(City)
                                         
                 (State)
                             (zip)
 

(Contract/Provider
No.)                                      (Vendor/Facility
No.) 

        The
Texas Department of Human Services, hereinafter referred to as, the Department, and the above nursing facility, hereinafter referred to as the Facility, hereby make and enter into
this contract for the consideration set forth below upon signatures of both parties, effective the 1st Day of August, 2002 and continuing until terminated as provided herein, in the Department's
rules, or in federal rules or law. 

I. 

        The
Department is responsible for administering the Long Term Care Program under the Texas Medical Assistance Program operated under Title XIX of the Social Security Act. This
citation is: 42 U.S.C. sections 1396-1396v (Medical Assistance Program). The Facility is licensed by the Department to provide nursing facility services. Since the Department
wishes to provide qualified individuals with services of the type furnished by the Facility, and since the Facility has filed an application to furnish such services, the Department and the Facility
mutually agree to the terms and conditions set forth below and to the provisions of the Nursing Facility Requirements for Licensure and Medicaid Certification (NFR/LMC) published by the Department, a
copy of which has been furnished to the Facility and which is hereby incorporated by reference as a part of this contract. 

II. 

The
Facility agrees: 

        A.    To
provide room and board, institutional services and medical and nursing facility services in the form of nursing care as defined in Title XIX of the Social
Security Act, as amended, in the NFR/LMC published by the Department, and in Department's regulations: 40 TAC 19, to residents found by the Department to be eligible for such services,
and to accept the vendor payment which is now in effect, or as it may hereafter be amended, as payment in full for the care of the resident, and to make no additional charge except the applied income
amount specified by the Department to the resident, any member of his family, or to any other source for any supplementation or for any item except as allowed within Departmental policies and
regulations. As a condition of eligibility for Medicaid benefits, the recipient has assigned all rights of recovery from any third party, or any other source of payment, to the Department
(42 CFR 433.145 and section 32.033 of the Texas Human Resources Code). Federal law prohibits the Facility from charging a recipient or any financially responsible relative or
representative of the recipient for Medicaid covered services, except where a co-payment is authorized under Medicaid State plan (42 CFR 447.20); 

        B.    To
disclose information on ownership and control, management information related to business transactions, past criminal activities and information on persons convicted
of crimes in accordance with 42 CFR part 455, subpart B, and provide such information on request to the Department, the Texas Health and Human Services Commission, the Texas
Department of Health, the Texas Department of Protective and Regulatory Services, the Texas Attorney General's Medicaid Fraud Control Unit, the Health Care Financing Administration and/or the United
States Department of Health and Human Services. The Facility agrees to keep its application for participation in the Medicaid program current by informing the Department or its agent in writing of any
changes to the information contained in its application, including but not limited to, changes in ownership or control, federal tax identification number, or provider business addresses, prior to
making such changes. The Facility understands that the application is hereby made a part of the contract and that each succeeding change in the information contained in the application requires
disclosure to the Department. Failure to keep the information current is a breach of contract; 

        C.    To
notify the Department or its agent within ten (10) business days of the time it receives notice that any action is being taken against the Facility or any
person defined under any of the provisions of section 1128(a) or (b) of the Social Security Act (42 USC 1320a-7), or Executive Order 12549 entitled "Deparment
and Suspension", which could result in exclusion from the Medicaid program. The Facility has not been excluded or debarred from participation in any program under Title XVIII (Medicare):
42 U.S.C. sections 1395-1395cc or any program under Title XIX (Medicaid) 42 U.S.C. sections 1396-1396v under any of the aforementioned
provisions. The Facility agrees to comply with 45 CFR part 76. This regulation requires the Facility, in part, to: (a) execute the attached Certification Regarding Debarment,
Suspension, Ineligibility and Voluntary Exclusion-For Covered Contracts upon execution of this agreement; (b) provide written notice to the Department or its agent if at any time
the Facility learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances; and (c) requires compliance with 45 CFR part 76
by participants in lower tier covered transactions; 

        D.    To
inform the Department within time limits specified in the Medicaid Provider Manual For Long Term Care Facilities, or its successor, when individuals covered under the
Title XIX Medical Assistance Program enters or leaves the facility; 

        E.    To
allow Department personnel, Texas Department of Health Personnel, Texas Attorney General Medicaid Fraud Control Unit personnel, and personnel of the United States
Department of Health and Human Services access to and private interviews with individuals receiving any type of assistance from the Department, and to allow review and/or audits of all Facility
records at all reasonable times. The Texas Attorney General's Medicaid Fraud Control Unit and the Texas Health and Human Services Commission's Office of Investigations and Enforcement may conduct
interviews of Facility personnel, subcontractors and their personnel, witnesses, and residents without the Facility's 

representative
or Facility's legal counsel present unless the person voluntarily requests that the representative be present. Facility's personnel, subcontractors and their personnel, witnesses, and
residents must not be coerced by the Facility or the Facility's representative to accept representation by the Facility, and Facility agrees that no retaliation will occur to a person who denies the
Facility's offer of representation. Nothing in this contract limits a person's right to counsel of his or her choice. Requests for interviews are to be complied with in the form and manner requested.
The Facility will ensure by contract or other means that its personnel and subcontractors over whom the Facility has control cooperate fully in any investigation conducted by the Texas Attorney
General's Medicaid Fraud Control Unit and/or the Texas Health and Human Services Commission's Office of Investigations. Subcontractors are those persons or entities who provide medical goods or
services for which the Facility bills the Medicaid program or who provide billing services in connection with Medicaid-covered services; 

        F.     To
keep the financial and supporting documents, statistical records, and any other records pertinent to the services for which a claim was submitted. The resident's
medical records and documents will be kept for a minimum of five (5) years after the termination of the contract period. If any litigation, claim, or audit involving a resident's medical
records begins before the five year period expires, the Facility will keep the records and documents for not less than five years and until all litigation, claims, or audit findings are resolved.
Other Facility records and documents will be kept a minimum of three years and ninety days after the termination of the contract period. If any litigation, claim or audit involving these records
begins before the three year and ninety day period expires, the Facility will keep the records and documents for not less that three years and ninety days and until all litigation, claims or audit
findings are resolved. The case is considered resolved when there is a final order issued in litigation, or a written agreement is entered into between the Department and the Facility. Contract period
means the beginning date to the termination date as specified in the Department rules, or in federal rules or law. This agreement is subject to all state and federal laws and regulations relating to
fraud and abuse in health care and the Medicaid program. As required by 42 CFR 431.107, the Facility agrees to keep any and all records necessary to disclose the extent of services
provided by the Facility to individuals in the Medicaid program and any information relating to payments claimed by the Facility for furnishing Medicaid services. The Facility also agrees to provide,
on request, access to records required to be maintained under 42 CFR 431.107 and to provide copies of those records to the Texas Health and Human Services Commission, the Texas Attorney
General's Medicaid Fraud Control unit, and/or the United States Department of Health and Human Services. Facility must cooperate and assist the Department and any state or federal agency charged with
the duty of identifying, investigating, sanctioning,. or prosecuting suspected fraud and abuse. Facility must also allow these agencies and/or their agents access to its premises; 

        G.    To
meet the provisions of the Life Safety Code of the National Fire Protection Association, as amended, applicable to nursing facilities; 

        H.    To
maintain a separate trust fund for each resident who entrusts personal funds to the personnel of the Facility; detailed records will be maintained of all receipts and
of all expenditures of such trust funds; such trust funds will not be commingled with the Facility's funds; 

        I.     Comply
with Title VI of the Civil Rights Act of 1964 (Public Law 88-352), Section 504 of the Rehabilitation Act of 1973 (Public
Law 93-112), The Americans with Disabilities Act of 1990 (Public Law 101-336), and all amendments to each, and all requirements imposed by the regulations issued
pursuant to these acts. In addition, the Facility agrees to comply with Title 40, Chapter 73, of the Texas Administrative Code. These provide in part that no persons in the United States
shall, on the grounds of race, color, national origin, sex, age, disability, political beliefs or religion be excluded from participation in, or denied, any aid, care, service or other benefits
provided by federal and/or state funding, or otherwise be subjected to discrimination. In addition, the Facility will comply with the Health and Safety Code Section 85.113 (relating to
workplace and confidentiality guidelines regarding AIDS and HIV); 

        J.     To
comply with the requirements of the Immigration Reform and Control Act of 1986 (8 USCA 1324a) regarding employment verification and retention of
verification forms for any individuals hired on or after November 6, 1986 who will perform any labor or services under this contract; 

        K.    To
submit claims for payment, including electronic claims, in accordance with billing guidelines and procedures promulgated by the Department. If the Facility submits
electronic forms to the Department or its agent by any method, the Facility will ensure that every machine readable form entry submitted by the Facility or their billing agent is capable of being
associated and identified with corresponding source documents (hard copies). The source documents must contain true and accurate information as specified in the NFR/LMC published by the Department,
and contain all required signatures appropriate to the form being submitted. The signatures that are required are as follows: 

	a.
	Form 3618:
Administrator 
	b.
	Form 3619:
Administrator 
	c.
	Form 3652:
Attending/Admitting Physician Director of Nurses Assessor 

The
Facility certifies that information submitted regarding claims will be true, accurate and complete, and that such information can be verified by source documents from which data entry is made by
the Facility. The Facility understands that payment of the claim will be from federal and state funds and that any falsification or concealment of a material fact may be prosecuted under federal and
state laws. This clause is pursuant to Sec. 403.055(h) of the Government Code. Any payments owing to the Facility under this contract will be applied toward elimination of the Facility's
indebtedness to the state, delinquency in payment of taxes to the state, or delinquency in payment of taxes that the Comptroller administers or collects until the indebtedness or delinquency is paid
in full. This clause does not apply if federal law requires payment to be made to the Facility for Nursing Facility Services under the Texas Medical Assistance Program, and may not apply if federal
law conditions the receipt of the money for these services to the state on the basis of payment being made to the Facility. 

        L.    To
notify the Department thirty (30) days in advance if the business entity files for bankruptcy, dissolves, or otherwise ceases to be an operating business; 

        M.   To
comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375 and supplemented in Department of Labor
regulations at 41 CFR part 60; 

        N.    To
comply with applicable provisions of the Clean Air Act (42 U.S.C. 7401 et seq.) and the Federal Water Pollution Control Act, as amended
(33 U.S.C. 1251 et seq.); 

        O.    That
the following statement required by law is true and correct: Under Section 231.006, Family Code, the Facility certifies that the individual or business entity
named in this contract, bid, or application is not ineligible to receive the specified grant, loan, or payment and acknowledges that this contract may be terminated and payment may be withheld if this
certification is inaccurate. 

III. 

The
Department agrees: 

        A.    To
pay on a vendor basis for nursing facility services (in amounts and under conditions determined by the Department) for all persons receiving such services who have
been determined by the Department to be eligible for such assistance under the Title XIX Medical Assistance Program; 

        B.    To
make all payments in accordance with the applicable laws as promptly as feasible after a proper bill is submitted and approved; 

        C.    To
make proper adjustment in the vendor payments from month to month as indicated to compensate for prior overpayment or underpayment; 

        D.    To
give to the Facility reasonable notice of any impending change in its status as a participating nursing facility in the Texas Medical Assistance Program, except that
nothing in this 

section
shall be construed to deny the Department the right, for failure to comply with the NFR/LMC published by the Department 40 TAC 19, or the contract, to take any one or more of the
following actions: (1) cancel the contract, (2) suspend vendor payments, or (3) any other legal remedy available to the Department; 

        E.    To
provide an administrative hearing to the Facility in the event the Department suspends or cancels the Facility's participation in the Title XIX Medical Assistance
Program; 

        F.     To
notify the Facility in writing of any deficiency(ies) found to exist. 

IV. 

The
Department and the Facility mutually agree: 

        A.    That
in the event the Federal and/or State laws or other requirements should be amended or judicially interpreted so as to render the fulfillment of this contract on the
part of either party unfeasible or impossible, or if the parties to this contract should be unable to agree upon modifying amendments which would be needed to enable its substantial continuation as
the result of the aforesaid amendments or judicial interpretations, then, and in that event, both the Facility and the Department shall be discharged from further obligation created under the terms of
this contract, except for the equitable settlement of the respective accrued interest up to the date of the termination; 

        B.    That
the Department may withhold payments, in whole or in part, if necessary because of irregularity(ies) or difference(s) from whatever cause until such
irregularity(ies) or difference(s) can be adjusted; 

        C.    That
this contract shall be in effect beginning on the date set out herein, and shall continue indefinitely, subject to the availability of appropriated funds or until
the Federal and/or State Governments cease to participate in the program, or by mutual consent of the Department and the Facility. Nothing in this section shall be construed to forbid the Department
from terminating this contract when it is established that the Facility is failing to comply with the terms of this contract and the Nursing Facility Requirements for Licensure and NFR/LMC, as they
now read or as they may be amended; 

        D.    That
as the Department amends, modifies, or changes the Nursing Facility Requirements for Licensure and NFR/LMC published by the Department, it shall immediately furnish
the Facility a copy of any such changes and that the Facility shall accept such amendment, modification, or change by acknowledging such change within twenty (20) days from receipt thereof;
such signed acknowledgment by the Facility shall become incorporated by reference as a part of this contract; and the failure of the Facility to execute and return the acknowledgement to the
Department may, at the Department's option, serve as sufficient justification for termination of the contract; 

        E.    That
any breach or violation of any of the provisions of the contract, or the NFR/LMC 40 TAC 19 published by the Department, shall make this entire contract, at the
Department's option, subject to cancellation; 

        F.     It
is agreed and understood that by signing this contract the Facility and the Department accept all the stipulations in the contract, and agree to each and every
provision therein and further agree that this contract shall be considered completed and executed and this contract shall be binding on the said Facility and the Department at such time as the
Department notifies the Facility of its participation status; 

        G.    It
is agreed and understood that the venue for any lawsuit between the Department and the Facility which is related to the performance of this contract shall be in Travis
County, Texas; 

        H.    That
payments under this contract may be withheld during the pendency of an administrative hearing on contract cancellation, termination or loss of certification of
compliance for Medicaid until a final decision is issued and all appeals are exhausted; 

        I.     That
this contract is dependent upon the Facility having a certification of compliance with Medicaid nursing facility standards. This contract is automatically terminated
on the date the Facility loses its certification of compliance. The Facility is not entitled to payment for services delivered to Medicaid clients during the time the Facility does not have a
certification of compliance. The Department will not pay the Facility during the pendency of an administrative hearing on a contract termination which is based on loss of certification of compliance; 

        J.     That
the Department, pursuant to the Human Resources Code, Sec. 32.021, may assess monetary penalties against the Facility for contract violations as required by
42 U.S.C.A. §1396 r (h). Such assessments are to be applied in accordance with Department rules at 40 T.A.C. §19.2121 and shall be in addition to
any other penalties and/or sanctions authorized by federal or state law and regulations. 

The
parties bind themselves by their respective signatures below. 

	TEXAS DEPARTMENT OF HUMAN SERVICES	 	[NAME OF FACILITY] dba [DBA NAME]
	

 	
 	

 	
 	

 
	BY:	 	 	 	 
	 	 	
	 	

	[P.M. Name], Program Manager	 	(Signature of Signatory per form 2031)
	Contract and Licensing Program	 	 
	Facility Enrollment Section	 	

	Long Term Care Regulatory	 	(Typed/Printed Name as per form 2031)
	

 	
 	

 	
 	

 
	 	 	 	 	

	 	 	 	 	(Title of Signatory)

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