Adopt Chapter Rev 2600 to read as follows:

CHAPTER Rev 2700 NURSING FACILITY QUALITY ASSESSMENT

PART Rev 2701 DEFINITIONS

Rev 2701.01 “ACH debit payment” means the electronic transfer of funds from the nursing facility’s account which is initiated by its authorized officer or representative and cleared through ACH for deposit into the account as provided in RSA 84-C:5.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

Rev 2701.02 “Automated clearing house (ACH) means a central distribution and settlement point for the electronic clearing of money transfers between financial institutions.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

Rev 2701.03 "Department" means the department of revenue administration.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss and moved by #8371, eff 6-8-05 (from Rev 2701.01)

Rev 2701.04 "Net patient services revenues" means “net patient services revenues” as defined in RSA 84-C:1, IV.

Source. #8371, eff 6-8-05 (from Rev 2701.02)

Rev 2701.05 "Nursing facility" means a nursing facility, as defined in RSA 151-E:2, V, subject to the RSA 84-C, nursing facility quality assessment.

Source. #8371, eff 6-8-05 (from Rev 2701.03)

PART Rev 2702 FORMS

Rev 2702.01 Availability of Forms. Forms may be obtained by:

(a) Writing to:

New Hampshire Department of Revenue Administration

Document Processing Division

P.O. Box 637

Concord, NH 03302-0637; or

(b) Calling the forms line at (603) 271-2192.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

Rev 2702.02 Form DP-156, Nursing Facility Quality Assessment Return.

(a) Form DP-156, “Nursing Facility Quality Assessment Return”, shall be completed and filed by nursing facilities to report their net patient services revenue to the department by providing the following:

(1) The nursing facility’s name and address;

(2) Federal employer identification number;

(3) The assessment period for which the return is filed;

(4) An indication if the return is an initial, amended or final return;

(5) The assessment calculation consisting of the net patient services revenue multiplied by the assessment rate;

(6) The amount of payments to be made by electronic transfer for the assessment period; and

(7) Dated signature, in ink, and title of an authorized representative of the nursing facility.

(b) If the return was completed by a paid preparer, the preparer shall:

(1) Sign and date the return, in ink;

(2) Provide the preparer’s federal employer identification number; and

(3) Provide the preparer’s complete mailing address.

(c) The nursing facility shall be required to file the return but not remit the payment, if the resulting assessment is less than $1.00.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

Rev 2702.03 Form DP-156-ACH, Nursing Facility Quality Assessment Authorization Agreement for Pre-Authorized Payments.

(a) All nursing facilities shall remit payments to the state treasurer by ACH debit payment.

(b) Form DP-156-ACH, “Nursing Facility Quality Assessment Authorization Agreement for Pre-authorized Payments”, shall be completed and filed by nursing facilities 30 days prior to the first filing of Form DP-156, “Nursing Facility Quality Assessment Return”, in order to register for remitting tax payments by ACH debit with the department, by providing all of the following:

(1) The nursing facility’s name and address;

(2) Federal employer identification number;

(3) An indication if the authorization is an initial, change, or revocation request;

(4) Depository (bank) information to include:

a. Name of the bank;

b. Name on account;

c. Account number;

d. Routing and transit number;

e. Federal identification or social security number on the account; and

f. An indication if the account is savings or checking;

(5) ACH authorization shall include:

a. Signatures, in ink, of the primary and secondary name and telephone numbers for contacts at the nursing facility for questions concerning ACH debit authorization; and

b. Acknowledgement that the authorization for ACH debit shall remain in full force and effect until the department has received written notice from the nursing facility requesting revocation of the authorization for ACH debit, provided that the department and depository have reasonable opportunity to act upon the request;

(6) Dated signature, in ink, of an authorized officer or representative;

(7) Title of an authorized officer or representative; and

(8) A copy of a voided check or savings withdrawal slip for the account to be debited.

(1) Debited 2 days prior to the last business day of the month following the due date of the return; or

(2) Debited on the date stated in an extension or installment payment agreement granted by the department.

(d) An ACH debit pre-note is required for the initial request and any changes.

(e) Any request for changes to or revocation of the authorization of the information provided in (b) shall constitute the filing of a new Form DP-156-ACH and shall be filed at least 30 days prior to the change or revocation.

Source. #8371, eff 6-8-05

PART Rev 2703 ADMINISTRATION

Rev 2703.01 Nursing Facility Records and Information. Every nursing facility shall maintain all accounting, financial or general records and information necessary to establish the amount of net patient services revenue or other information required to be shown on any return, schedule or attachment pursuant to the requirements under RSA 84-C:8.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

Rev 2703.02 Examination of Records and Information. In any examination of the records and information of a nursing facility, the department shall first review records and information required to be filed with the commissioner of the department of health and human services.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

Rev 2703.03 Installment Plans.

(a) A nursing facility may request, in writing, to enter into an installment plan with the department for the payment of assessments within the requirements of RSA 21-J:43.

(b) The department may, pursuant to RSA 21-J:43, modify or terminate the agreement on the installment plan if:

(1) The taxpayer breaches the terms of the agreement; or

(2) Documentation shows any changes that would alter the taxpayer’s financial condition.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

Rev 2703.04 Extension of Time for Filing Return.

(a) A nursing facility may request in writing, that the commissioner extend the time for the filing of Form DP-156 pursuant to RSA 84-C:7.

(b) Such a request shall:

(1) Be made on or before the due date of the return;

(2) Contain a specific date by which the return shall be filed; and

(3) Explain why:

a. An extension is necessary; an

b. The date in (2) above is attainable.

Source. #8226, INTERIM, eff 12-10-04, EXPIRES: 6-8-05; ss by #8371, eff 6-8-05

APPENDIX

RULE	STATUTE IMPLEMENTED

Rev 2701.01	RSA 84-C:1, I
Rev 2701.02	RSA 84-C:1, IV
Rev 2701.03	RSA 84-C:1, V
Rev 2702.01	RSA 84-C:4
Rev 2702.02	RSA 84-C:4
Rev 2702.03	RSA 84-C:5
Rev 2703.01	RSA 84-C:8
Rev 2703.02	RSA 84-C:10
Rev 2703.03	RSA 21-J:43
Rev 2703.04	RSA 84-C:7