Illinois Administrative Code › Title 86 - REVENUE › Part 535 - NURSING HOME GRANT ASSISTANCE ACT › Section 535.110 - Grant Applications/Distribution Agents

Current through Register Vol. 48, No. 28, July 12, 2024
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:
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:
My name is:
;
My Social Security Number is:
;
I am not a recipient of federal, State, or combined
						  federal and State medical care program payments (other than Medicare Part B
						  benefits);
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:
$
; and
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.
Signed: (eligible individual's signature)
Eligible Individual's Printed Name
Date:
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.