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  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 06/21/07

Revised Form HFS 1156, Long Term Care Facility Notification

 

To:​

Intermediate Care Facilities for the Developmentally Disabled (ICF/DD)​
Date:​ June 21, 2007​
Re:​ Revised Form HFS 1156, Long Term Care Facility Notification​

 

Form HFS 1156, Long Term Care Facility Notification, has been revised by adding a “Place of Birth” field at the top of the form.

 

Copies of this and previous notices may be found on the department’s Web site at: www.hfs.illinois.gov/ltc/

The revised Form HFS 1156 may be downloaded at:

www.hfs.illinois.gov/medicalforms/

If you have any questions, contact the Bureau of Long Term Care at 217-782-0545.

Theresa A. Eagleson, Administratorr

Division of Medical Programs