a) An application under the Act is completed
by the payment on or after July 1, 1992, by an eligible individual of at least
$1.00 in a calendar quarter to a nursing home and by the receipt by a nursing
home of at least $1.00 from an eligible individual that is a resident of the
home.
b) A nursing home which
receives one or more applications under the Act is a "distribution agent" under
that Act. A distribution agent is required to gather such information, submit
such certifications and distribute such payments as are required to be
gathered, submitted and distributed by the Act. A distribution agent, and the
responsible officers and employees of such an agent, are subject to penalties
and enforcement action under the Act and this Part for failing to perform such
functions as are required by the Act for submitting certifications to the
Department, receiving grant payments from the Department and making grant
distributions to eligible individuals.
c) A
nursing home must at all times maintain
for its
records, subject to inspection by the
Department, a statement signed
and executed by each eligible individual or the
eligible individual's legally
authorized representative in substantially the following form:
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I (eligible individual's name), for purposes of
receiving such payments as I may be entitled to receive under the Nursing Home
Grant Assistant Act, do hereby authorize (distribution agent's name) to
disclose to the Illinois Department of Revenue that:
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My name is:
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;
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My Social Security Number is:
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;
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I am not a recipient of federal, State, or combined
federal and State medical care program payments (other than Medicare Part B
benefits);
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My Annual Adjusted Gross Income After Subtraction For
Nursing Home Care Expenses not paid for, in whole or in part, by a federal,
State or combined federal-State medical care program (other than Medicare Part
B benefits), is:
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$
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; and
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I understand that the (distribution agent's name) is
required to pay to the Department of Revenue a fee of $1.00 per occupied bed
day after June 30, 1992 and before July 1, 1993, and that (distribution agent's
name) is prohibited by law from passing on to me, or otherwise charging to me,
directly or indirectly, the $1.00 fee.
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Signed: (eligible individual's signature)
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Eligible Individual's Printed Name
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Date:
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Such a statement shall be made for each eligible individual in
the first quarter for which such individual becomes eligible to receive a
Nursing Home Grant Assistance Act payment.
d) A distribution agent that receives
Nursing
Home Grant Assistance
Act grant payments for an individual for whom no
statement was executed and maintained as required by subsection (c) above, will
be presumed to have received a grant payment and not have distributed the
payment to the eligible individual within two working days from the date of
receipt and shall be subject to the penalties applicable under the
Act for such
failure, as provided by Section
535.150 of this Part.
