provider
agreement.
(1)
ODM
shall terminate, deny, or not revalidate a NF provider agreement for, but not
limited to, the following reasons:
(a)
The provider has been terminated, suspended, or
excluded by the medicare program and/or by the United States centers for
medicare and medicaid services (CMS) and that action is binding on
participation in the medicaid program or renders federal financial
participation unavailable for participation in the medicaid program. Under
these conditions, medicaid termination and payment sanction dates shall be the
same as medicare termination and payment sanction dates.
(b)
The facility has
been decertified by ODH and/or the United States department of health and human
services.
(c)
The provider has pled guilty to or been convicted of a
criminal activity materially related to either the medicare or medicaid
program.
(d)
Any license, permit, or certificate that is required by
ODM or the terms of the provider agreement has been denied, suspended, revoked,
or not renewed.
(1)
(2)
ODJFS
ODM
shall terminate, deny, or not
renew
revalidate a
NF
provider agreement
when any of the situations set
forth in division (D) of section 5111.06 of the Revised Code occur
for,
including,
but not limited to, the following
reasons set forth in
Chapters 5164. and 5165. of the Revised Code, and Chapters 5160-1 and 5160-3 of
the Administrative Code:
(a) The provider has been
terminated, suspended, or excluded by the medicare program and/or by the United
States centers for medicare and medicaid services (CMS) and that action is
binding on participation in the medicaid program or renders federal financial
participation unavailable for participation in the medicaid program. Under
these conditions, medicaid termination and payment sanction dates shall be the
same as medicare termination and payment sanction dates;
(b) The facility has been
decertified by the Ohio department of health (ODH) and/or the United States
department of health and human services;
(c)
(a)
The provider, or its owner, officer, authorized
agent, associate, manager, or employee has pled guilty to or been convicted of
a criminal offense, found liable in a civil action, or voluntarily settled a
civil suit brought pursuant to section 109.85 of the Revised Code;
In accordance with division (D) of section
5164.35 of the Revised Code,
there has been a conviction of, or the entry of a judgment in either a criminal
or civil action against the provider or its owner, officer, authorized agent,
associate, manager, or employee in an action brought pursuant to section
109.85 of the Revised
Code.
(d)
(b) The provider has committed medicaid fraud as
defined in rule 5101:3-1-29
5160-1-29
of the Administrative Code;
.
(c)
In accordance
with section 5165.073 of the Revised Code,
the provider does not comply with the requirements of section
3721.071 of the Revised Code for
the installation of fire extinguishing and fire alarm systems.
(d)
Any of the
scenarios specified under division (B) of section
5165.771 of the Revised Code
regarding the special focus facility program apply to the
provider.
(e)
In accordance with section
5165.106 of the Revised Code,
the provider fails to file a cost report required by section
5165.10 of the Revised Code by
the date it is due or by the date, if any, to which the due date is extended
pursuant to division (D) of section
5165.10 of the Revised Code,
unless the provider submits a complete and adequate cost report within thirty
days after notice of termination by ODM.
(e) The provider has pled guilty to
or been convicted of a criminal activity materially related to either the
medicare or medicaid program; or
(f) Any license, permit, or
certificate that is required by ODJFS or the terms of the provider agreement
has been denied, suspended, revoked, or not renewed.
(g)
(f)
The provider has failed to ensure a nursing facility's full participation in
the medicare program as a skilled nursing facility (SNF) pursuant to section
5111.21
5165.082
of the Revised
Code and rule 5101:3-3- 02.4
5160-3- 02.4 of the Administrative Code.
(g)
In accordance
with section 5165.072 of the Revised Code,
the provider fails to maintain eligibility for the provider agreement as set
forth in section 5165.06 of the Revised
Code.
(h)
In accordance with division (B)(1) of section
5164.32 of the Revised Code, the
provider fails to file a complete application for revalidation within the time
and in the manner required by the revalidation process as specified by
ODM.