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.