Ill. Admin. Code tit. 86 § 535.120

Current through Register Vol. 48, No. 50, December 13, 2024

Section 535.120 - Certification by Distribution Agent

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.

Ill. Admin. Code tit. 86, § 535.120