TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.101 PURPOSE OF THE PROGRAM
Section 535.101 Purpose of
the Program
a) The Nursing Home Grant Assistance Act (P.A. 87-863, effective
July 9, 1992) [305 ILCS 40/1 et seq.] ("the Act") is a remedial
statute. The purpose of the Act is to provide for individuals in need of financial
support and who reside in a skilled nursing or intermediate long term care
facility that is licensed by the Illinois Department of Public Health under the
Nursing Home Care Act (Ill. Rev. Stat. 1991, ch. 111½, pars. 4151-101, et seq.)
[210 ILCS 45/1-101], after June 30, 1992 and before July 1, 1993, whose nursing
home care is 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), and whose annual adjusted gross income, after subtracting the amount
of payments for nursing home care expenses, does not exceed 250% of the federal
poverty guidelines for an individual as published annually by the U.S.
Department of Health and Human Services for purposes of determining Medicaid
eligibility, to receive financial assistance in the form of Nursing Home
Grant Assistance grant payments distributed to them by the skilled nursing or
intermediate long term care facility in which such individuals reside. (Section
5 of the Act)
b) The Department is empowered by Section 40 of the Act to adopt
necessary rules to implement this Act, and to use its emergency rulemaking
authority to adopt initial rules. Under Section 20(b)(1) of the Act it is
necessary to use the Nursing Home Grant Assistance Fund to disburse moneys for
payment of grants to eligible individuals under the Act. Under Section 25 of
the Act it is necessary to make such payments of grants to eligible individuals
through the skilled nursing or intermediate long term care facility in which
such individuals reside. Under Section 20 of the Act, within 10 days after
receipt by the State Comptroller of the disbursement certification made by the
Department, the State Comptroller shall cause warrants to be drawn for the
respective amounts in accordance with the directions contained in that
certification. To assure that eligible individuals receive the grant payments
made to them through the skilled nursing or intermediate long term care
facilities in which such individuals reside, the Department is empowered under
Section 35 of the Act to impose penalties upon, and take action to collect such
penalties against, these facilities for their failure to file the
certifications required by the Act, to pay the fees due under the Act, and to
distribute the grants to the individuals to whom payment is made.
 | TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.105 DEFINITIONS
Section 535.105 Definitions
For purposes of the Nursing Home
Grant Assistance Act and this Part:
"Department" means the Illinois Department of
Revenue.
"Eligible individual's annual income from all
sources" and "annual adjusted gross income" have the same
meaning as "adjusted gross income" in Section 2-203(a)(1) of the
Illinois Income Tax Act (Ill. Rev. Stat. 1991, ch. 120, pars. 1-101 et seq.)
[35 ILCS 5/101 et seq.] ("the IITA"), before the modifications
thereto required by Section 2-203(a)(2) of the IITA. An individual, or the
individual's legally authorized representative, may use the following amounts
to determine adjusted gross income:
the amount reported by a resident on Line 1 of the IL-1040
individual Illinois income tax return filed by or on behalf of such resident
for the tax year immediately preceding a certification filed under the Act by a
distribution agent; or
the amount reported by a resident on Line 31 of the U.S.
1040, or Line 16 of the U.S. 1040A, or Line 3 of the U.S. 1040EZ individual
federal income tax returns filed by or on behalf of such resident for the tax
year immediately preceding a certification filed under the Act by a distribution
agent.
"Eligible individual's legally authorized
representative" has the same meaning as "resident's
representative" in Section 1-123 of the Nursing Home Care Act.
"Expenses for nursing home care" means all amounts
paid by a resident, or on behalf of a resident, for personal care provided to
the resident by a nursing home, or for personal care provided to the resident
on the nursing home premises, or such personal care as cannot reasonably be
provided on the premises, by someone other than the nursing home. In the case
of an individual who has been a resident in a nursing home for a full 12 month
period prior to the first day for which nursing home grant assistance is
sought, "expenses for nursing home care" means the amount of such
expenses for that 12 month period, or calendar year 1991. In the case of an
individual who has been a resident in a nursing home for less than a 12 month
period prior to the first day for which nursing home grant assistance is
sought, "expenses for nursing home care" means that individual's
average monthly expense for nursing home care for such period of residence
multiplied by 12.
"Nursing home" means a skilled nursing or
intermediate long term care facility that is subject to licensure by the
Illinois Department of Public Health under the Nursing Home Care Act.
"Nursing Home Grant Assistance payment" means a
payment made by the Comptroller to an eligible individual under the Act in the
amount certified to the Comptroller for such individual by the Department.
"Occupied bed" days means the sum for all beds of
the number of days during a quarter for which grant assistance is sought under
the Act on which a bed is occupied by an individual. Bed hold days are not
included by this definition.
"Personal care" has the same meaning as in Section
1-120 of the Nursing Home Care Act.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.110 GRANT APPLICATIONS/DISTRIBUTION AGENTS
Section 535.110 Grant
Applications/Distribution Agents
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.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.115 DETERMINATION OF ELIGIBILITY
Section 535.115
Determination of Eligibility
An individual who is a resident
in a nursing home during one or more days after June 30, 1992 and before July
1, 1993 is eligible to receive assistance under the Act if he or she meets the
following criteria:
a) For each day for which nursing home grant assistance is
sought, the individual's nursing home care was 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); and
b) The individual's annual adjusted gross income, after
payment of expenses for nursing home care, does not exceed 250% of the federal
poverty guidelines for an individual as published annually by the U.S.
Department of Health and Human Services for purposes of determining Medicaid
eligibility. (Section 5 of the Act)
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.120 CERTIFICATION BY DISTRIBUTION AGENT
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.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.125 PAYMENT OF FEES BY DISTRIBUTION AGENTS
Section 535.125 Payment of
Fees by Distribution Agents
The total amount of fees shown
in the Certification shall be paid to the Department with Form NH-1 of the
Certification filed with the Department. A distribution agent shall compute
the fee as provided in Section 535.120(b) of this Part. A Certification shall
be considered late, and the distribution agent shall be subject to penalties
under the Act, if the postmark date is after the last day of September,
December, March and June.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.130 QUALIFIED DISTRIBUTION AGENTS
Section 535.130 Qualified
Distribution Agents
a) Only a qualified distribution agent may receive Nursing Home
Grant Assistance payments for distribution to eligible individuals. A
distribution agent must be a qualified distribution agent each quarter that a
Certification is due. A distribution agent is a qualified distribution agent
only if:
1) the Certification is timely filed on or before the due date
for filing of the Certification;
2) the Certification filed with the Department is accompanied by
payment in full of the amount of fee shown to be due on the Certification.
b) The Department may periodically verify any information
provided in a Certification. The Department may also periodically verify that
Nursing Home Grant Assistance Payments sent to a distribution agent were in
fact timely distributed to eligible residents, and that the distribution agent
did not charge residents for the amount of the fee paid by the distribution
agent to the Department. Following such verification, the Department may give
written notification to a distribution agent that, based on the information
obtained through the verification process, the distribution agent will no
longer be a qualified distribution agent for purposes of distributing grants.
Such a notification does not exempt the distribution agent from the requirement
that a Certification be filed and that it pay the fee shown to be due therein.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.135 DISTRIBUTION OF GRANT PAYMENTS BY QUALIFIED DISTRIBUTION AGENTS
Section 535.135 Distribution
of Grant Payments by Qualified Distribution Agents
a) The Department shall cause Nursing Home Grant Assistance grant
payments to be issued to qualified distribution agents. If the amount
appropriated or available in the fund is insufficient to meet all or part of
any quarterly payment certification, then the total amount appropriated or available,
after subtracting 2½% of that amount, shall be divided by the total amount of
the quarterly grant certification. The factor resulting from that calculation
shall be applied to the total amount of each Nursing Home Grant Assistance
payment.
b) Nursing Home Grant Assistance payments must be distributed by
a qualified distribution agent to the named payee within 2 working days after
the date received by the distribution agent.
c) In order to avoid the imposition of penalties as provided by
the Act, a qualified distribution agent should notify the Department in writing
as soon as it becomes aware that it will not be able to make a distribution of
Nursing Home Grant Assistance payments to one or more eligible individuals, or
to the legally authorized representative of a deceased eligible individual,
within the time required by the Act. The written notification should state the
reason for the delay in making timely distribution and the expected date on
which payment is expected to be made. The written notification should be made
on or before the expiration of the 48 hour (or two business days) period for
distributing grant payments to an eligible individual, or on or before the 30th
day of the period for distributing a grant payment to the legally authorized
representative of an eligible individual that is deceased. Where an eligible
individual is deceased and payment must be made to the eligible individual's
legally authorized representative, the failure to give the written notification
herein specified shall submit the qualified distribution agent to the
imposition of penalties under the Act notwithstanding that the grant payment is
made to the legally authorized representative after the 30th day and on or
before the 120th day provided in Section 30 of the Act, and notwithstanding
that the undistributed grant payment is returned to the Department within the
120 day period provided in Section 30 of the Act.
d) A qualified distribution agent that is unable to locate the
legally authorized representative of an eligible individual that is deceased
shall within 120 days from the date that payment was made to the qualified
distribution agent by the Department return the grant payment that remains
undistributed to the Department.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.140 ALTERNATIVE MEANS OF DISTRIBUTION TO ELIGIBLE INDIVIDUALS
Section 535.140 Alternative
Means of Distribution to Eligible Individuals
When a distribution agent files
a Certification but does not become a qualified distribution agent with respect
to the quarter for which Nursing Home Grant Assistance is sought on behalf of
eligible individuals, the Department shall not issue a Nursing Home Grant
Assistance grant payment to the distribution agent to be distributed to
eligible individuals. In such cases, the Department shall notify the
distribution agent that it is not a qualified distribution agent authorized to
receive Nursing Home Grant Assistance grant payments on behalf of eligible
individuals included in the Certification filed by the distribution agent.
Such a notification does not exempt the distribution agent from the requirement
in a subsequent quarter that a Certification be filed and that it pay the fee
shown to be due therein. Where such notification is issued, the Department
shall distribute Nursing Home Grant Assistance grant payments through other
reasonable means to each eligible individual or, where the eligible individual is
deceased, to the legally authorized representative of an eligible individual.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.145 REFUNDS
Section 535.145 Refunds
a) An overpayment with respect to one quarter for which a
Certification is filed cannot be claimed through an off-set or other deduction
against the amount of fee due in a subsequent Certification.
b) A claim for refund of an overpayment of a fee under the Act
may be filed with the Department only if a Certification was filed for the
grant period for which a refund is claimed. Every claim for refund shall be in
writing, shall be on the appropriate form prescribed by the Department, and
(using attachments if necessary) shall state the specific grounds upon which
the claim is founded, and identify the specific period(s) and related
amount(s).
c) The Department shall examine a claim for refund as soon as
practicable after it is filed to determine the correct amount of fee and the
amount of any refundable overpayment to which the claimant may be entitled, in
connection with the Certification with respect to which an overpayment is
alleged. If the Department finds the claimant entitled to a refund in any amount
it shall issue a notice of refund. If the Department fails to approve or deny
the claim before the expiration of 6 months from the date the claim was filed,
the claimant may nevertheless thereafter file with the Department a written
protest within 60 days after the expiration of the 6 month period. If a
protest is filed the Department shall consider the claim and, if the claimant
has so requested, shall grant the claimant or the claimant's authorized
representative a hearing within 6 months after the date such request is filed.
(See Ill. Adm. Code 200 for the Department's Hearing Rules.) The procedure for
protest shall be the same in all other cases in which the Department issues a
denial of the claim within 6 months from the date the claim was filed, but the
protest must be filed within 60 days after the date the Department denies the
claim.
d) No claim shall be filed and no refund shall be allowed or made
if the claimant files a claim for refund after the expiration of a three year
period after the earlier of the date the Certification was filed or the date
the Certification was due.
| TITLE 86: REVENUE
CHAPTER I: DEPARTMENT OF REVENUE
PART 535
NURSING HOME GRANT ASSISTANCE ACT
SECTION 535.150 ASSESSMENTS/PENALTIES
Section 535.150
Assessments/Penalties
Section 35(c) of the Act
incorporates by reference certain provisions of the Retailers' Occupation Tax
Act. (Ill. Rev. Stat. 1991, ch. 120, pars. 440, et seq.) [35 ILCS 120/1, et
seq.] (the "ROTA") The Act authorizes the Department to issue notices
assessing liability for amounts of fees which are due and owing the Department
and for penalties that are imposed and become due under the Act.
a) As soon as practicable after a Certification is filed, the
Department shall examine such Certification and shall, if necessary, correct
such Certification according to its best judgement and information. Except in
the case of a fraudulent Certification, no notice of assessment for a
deficiency resulting from a correction made by the Department shall be issued
on or after 3 years after the later of the date the Certification was due or
the date the Certification was filed.
b) In case any distribution agent fails to file a Certification
when and as required by the Act, the Department shall determine the amount of
fees due from the distribution agent according to the Department's best
judgement and information. In such a case, and in case any distribution agent
files a Certification at the time required by the Act, but fails to pay the
fees, or any part thereof, when due, the Department shall issue a notice of
assessment for the amount of the deficiency resulting from the failure to pay
the amount determined by the Department to be due, or such amount as was
reported in the Certification but for which payment was not made to the
Department by the distribution agent. Section 35(c)(2) incorporates Section 5
of the ROTA, except that the penalty amounts provided for in the Act shall
control. Accordingly, a notice of assessment under this subsection may include
an amount equivalent to the underpayment of fees due from a distribution agent
or a qualified distribution agent and, in addition to that amount, an amount
equal to 100% of the underpayment. Except in case of failure to file a
Certification, or with the consent of the person to whom the notice of
assessment is to be issued, no notice of assessment shall be issued on and
after each July 1 and January 1 covering fees due during any month or period of
time more than 3 years prior to such July 1 and January 1, respectively.
c) An amount of penalty imposed pursuant to Section 35(a) of the
Act, and an amount of penalty imposed pursuant to Section 35(b) of the Act may
be included in a notice of assessment issued to a qualified distribution
agent. A notice of assessment including an amount of penalty imposed pursuant
to Section 35(a) or Section 35(b) of the Act may be issued at any time.
d) An amount of penalty imposed pursuant to Section 35(c)(4) of
the Act may be included in a notice of assessment.
e) If a protest to a notice of assessment is not filed within 60
days after such notice, such notice of assessment shall become final without
the necessity of a final assessment being issued and shall be deemed to be a
final assessment. If a distribution agent files a protest to a notice of
assessment within 60 days after such notice, and the protest requests a hearing
thereon, the Department shall give notice to the distribution agent of the time
and place fixed for such hearing and shall hold a hearing in conformity with such
provisions of the ROTA as are incorporated by reference by the Act, and
pursuant thereto shall issue a final assessment to such distribution agent or
to the legal representative of such person for the amount found to be due as a
result of such hearing.
f) In addition to the penalties provided for in the Act, any fee
that is not paid when due shall bear interest at the rate provided for in
Section 5 of the ROTA, incorporated by Section 35(c)(2) of the Act, from the
date when such fee becomes past due until such fee is paid or a judgement
therefor is obtained by the Department.
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