Illinois Administrative Code
Title 86 - REVENUE
Part 535 - NURSING HOME GRANT ASSISTANCE ACT
Section 535.120 - Certification by Distribution Agent

Universal Citation: 86 IL Admin Code ยง 535.120

Current through Register Vol. 48, No. 38, September 20, 2024

a) A Nursing Home Grant Assistance Certification ("Certification") shall consist of two forms issued by the Department: Form NH-1, Nursing Home Grant Assistance Certification and Form NH-2, Individuals Eligible For Grant. A Certification is not timely filed unless both Form NH-1 and Form NH-2 are filed with the Department on or before the due date for the Certification.

b) On or before the last day of September, December, March and June a nursing home that is a distribution agent under the Act shall file with the Department Form NH-1 of the Certification. Form NH-1 of the Certification shall contain the following information:

1) the total number of occupied bed days during the quarter, multiplied by $1.00;

2) the total amount of the fee due to the Department.

c) On or before the last day of September, December, March and June a nursing home that is a distribution agent under the Act shall file with the Department Form NH-2 of the Certification. Form NH-2 of the Certification shall contain the following information:

1) Distribution Agent Information. The Certification shall contain the name and address of the distribution agent, as well as:
A) the number of the license issued to the distribution agent under the Nursing Home Care Act by the Illinois Department of Public Health;

B) the distribution agent's Federal Employer Identification Number; and

C) the distribution agent's Illinois Business Identification Number.

2) Total Grant Calculation. The Certification shall disclose, for the quarter immediately preceding the quarter for which a certification is filed:
A) the name and social security number of each eligible individual and the total number of eligible individuals for whom a written authorization has been executed and is maintained on file as required by Section 535.110 of this Part; and

B) the total number of occupied bed days for each eligible individual included in the Certification, and the total number of occupied bed days for all eligible individuals.

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