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.

 

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.

 

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:

 

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.

 

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)

 

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.

 

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.

 

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.

 

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 30^th 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.

 

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.

 

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.

 

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.