(A)
Purpose
This rule clarifies conditions under which payment may be made
to an intermediate care facility for individuals with intellectual disabilities
(ICFIID) during proposed termination or non-renewal and upon termination or
non-renewal of the ICFIID's medicaid certification by the Ohio department of
health.
(B) Definitions
For the purposes of this rule, the following definitions
shall apply:
(1) "Effective date of termination" means the
date set by the Ohio department of health or the United States department of
health and human services for the termination of medicaid
certification.
(2) "Informal
reconsideration" is the process by which an ICFIID may refute in writing, prior
to the termination or non-renewal of medicaid certification, the Ohio
department of health's findings on which the termination or non-renewal is
based. The ICFIID must receive a written response to the informal
reconsideration request which either affirms or reverses the survey decisions.
Informal reconsideration is a process independent of the formal appeal. An
ICFIID may or may not choose to utilize informal
reconsideration.
(C)
Informal reconsideration
In addition to or in conjunction with the appeals process, an
ICFIID may request informal reconsideration. If informal reconsideration
results in an affirmation of the original survey findings, the appeals process
moves forward to the administrative hearing if one was requested. If informal
reconsideration results in a reversal of the original survey findings, the Ohio
department of health's termination or non-renewal action, based on those
original findings, is dismissed.
(D) Payment during the appeals process
(1) During the appeals process provided by
the Ohio department of health in accordance with rule
3701-63-01 of the Administrative
Code for the proposed termination or non-renewal of medicaid certification,
payment under regulations for covered services provided to eligible residents
shall
will
continue through the earlier of:
(a) The date
of issuance of a final order of adjudication that upholds the Ohio department
of health's termination or non-renewal action; or
(b) The one hundred twentieth calendar day
after the effective date of termination of the ICFIID's provider
agreement.
(2) Payment
may be provided up to an additional thirty calendar days following either the
cessation of payment on the one hundred twentieth calendar day post termination
or non-renewal
;
, or after the issuance of an adjudication order that
upholds the termination or non-renewal action. Payment will be available if
both of the following conditions are met:
(a)
Payment is for residents admitted to the ICFIID before the effective date of
termination or non-renewal; and
(b)
The ICFIID cooperates with federal, state, and local entities in the effort to
transfer residents to other facilities or community programs that can meet the
residents' needs.
(E) Payment following termination of medicaid
certification
(1) When the Ohio department of
medicaid acts under instructions from the United States department of health
and human services, payment ends on the termination date specified by that
agency.
(2) When the Ohio
department of health certifies that there is jeopardy to residents' health and
safety by issuing an order under Chapter 5165. of the Revised Code, or when
it
the Ohio
department of health fails to certify that there is no jeopardy, payment
will end on the effective date of termination.
(F) Termination of provider agreement When an
ICFIID's medicaid certification is terminated or not renewed, the Ohio
department of medicaid shall
will terminate the ICFIID's provider
agreement.
Notes
Ohio Admin. Code
5123-7-05
Effective:
6/30/2025
Five Year Review (FYR) Dates:
4/14/2025 and
06/30/2030
Promulgated
Under: 119.03
Statutory
Authority: 5123.04,
5124.03
Rule
Amplifies: 5123.04,
5124.03
Prior
Effective Dates: 01/10/2013,
12/16/2019
