Ohio Admin. Code 5160-3-02.1 - Nursing facilities (NFs): length and type of provider agreements
(A) Definitions.
(1) "Reasonable assurance period" means a
certain period of time, determined by the centers for medicare and medicaid
services (CMS), for which a long term
care
nursing facility operator whose
provider agreement has been involuntarily terminated is required to operate
without recurrence of the deficiencies that were the basis for termination.
Participation in the medicare and medicaid programs may resume only following
that period. If corrections were made before submission of a new request for
participation, the period of compliance before the new request is counted as
part of the period.
(2) "State
survey agency" means the agency that is under contract with the state medicaid
agency and that inspects long term care
nursing facilities for the purposes of survey and
certification. The state survey agency in Ohio is the Ohio department of health
(ODH). The state medicaid agency in Ohio is the Ohio department of
job and family services (ODJFS)
medicaid (ODM).
(B) Effective dates
- skilled nursing facilities (SNFs), nursing
facilities (NFs), and SNF/NFs.
(1)
Initial certification of NFs and skilled nursing
facilities/nursing facilities (SNF/NFs).
(a) Effective dates of NF and SNF/NF provider
agreements generally are assigned by the state survey agency on the basis of
findings of compliance or substantial compliance with standards of
certification.
(b) The effective
date shall not be earlier than the date on which compliance is documented via
the state survey agency's onsite visits to the institution
facility.
(c) The effective date of a provider
agreement of a nursing facility that participates in the medicaid program as a
SNF/NF shall be the same as that of the facility's medicare provider
agreement.
(2) NFs
subsequently approved to operate as SNF/NFs.
(a) Upon approval from CMS of a NF to
participate in the medicare program as a SNF/NF, ODJFS
ODM shall issue
a SNF/NF provider agreement.
(b)
The effective date of this provider agreement shall be the same as that of the
facility's medicare provider agreement.
(3) Re-entry into the program following
involuntary termination.
(a) Following
involuntary termination of the medicaid provider agreement for a nursing
facility, the provider agreement effective date of a facility re-entering the
medicaid program shall be the same effective date as the date CMS issues for
the facility's medicare provider agreement.
(b) Re-entry may occur only after the
successful completion of a reasonable assurance period as determined by
CMS.
(C) Term
limits - NFs and SNF/NFs.
(1)(2) The term of a
NF or SNF/NF provider agreement shall be
based on
determined
by the period of certification established by the state survey agency, which is based upon compliance with certification
standards. The term of a NF or SNF/NF provider agreement may be less than, but
shall not exceed, five years.
(1)
A NF or SNF/NF
provider agreement shall expire no later than five years from the effective
date of the agreement in accordance with section
5164.32 of the Revised Code. The
process for revalidation of a NF or SNF/NF provider agreement is specified in
rule 5160-1-17.4 of the
Administrative Code
(2) The actual term of the agreement
may be less than, but shall not exceed, the certification period recommended by
the state survey agency.
(3) NFs and SNF/NFs.
(a) NFs and SNF/NFs are governed by
open-end provider agreements.
(b) Open-end agreements have no
specific expiration date.
(c) Continuation of an open-end
provider agreement is contingent upon findings of continued compliance or
substantial compliance with certification standards as determined by the state
survey agency.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.32
Prior Effective Dates: 4/4/77, 12/30/77, 1/1/79, 3/23/79, 8/31/79, 11/1/79, 7/1/80, 7/7/80, 10/1/87, 1/1/95, 5/16/02, 9/29/05, 2/15/11, 1/10/13
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