Ill. Admin. Code tit. 86, § 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.
Notes
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