Get De Form Lq11_1206 2018-2026

Filling out the DE Form LQ11_1206 is essential for nursing facilities in Delaware to report quality assessment fees. This guide provides a clear, step-by-step approach to successfully complete the form online.

Follow the steps to complete the DE Form LQ11_1206 online

1. Click the ‘Get Form’ button to access the form and open it in your online editor.
2. Enter the account number in the specified field, ensuring to input it without any dashes.
3. Provide the business code group description.
4. Input the tax period ending date, using the format MM-DD-YY.
5. Fill in the facility name accurately.
6. Enter the facility location address, including city, state, and zip code.
7. If the mailing address is different from the facility address, complete that section with the required information.
8. Answer the questions about whether the nursing facility is required to file by selecting 'Yes' or 'No' for each query.
9. Enter the number of annual Medicaid patient days as detailed in the Medicaid Cost Report.
10. Provide the number of licensed nursing home beds.
11. Specify the number of assisted/independent living beds on the same campus.
12. Input the total number of nursing facility resident days.
13. Fill in the number of Medicare resident days.
14. Calculate the number of non-Medicare resident days by subtracting Medicare resident days from total resident days.
15. Enter the appropriate fee based on the number of annual Medicaid patient days from Line 1.
16. Calculate the total amount due by multiplying the value from Line 6 by the fee from Line 7.
17. Finally, declare the accuracy of your information by entering your printed name, title, date, and signature.
18. After ensuring all information is complete and accurate, you can save changes, download, print, or share the form.

Complete your DE Form LQ11_1206 online today for timely filing.