Current through all regulations passed and filed through September 16, 2024
(A) This rule
prescribes the procedure under which a nursing facility submits a plan of
correction for findings and deficiencies cited as the result of a survey by the
department of health. The rule also prescribes the procedure for a facility to
obtain informal review of deficiencies that were included on a statement of
deficiencies prepared by the department under 42 C.F.R. Part 488 (2011). As
used in this rule:
(1) "Nursing facility"
means a facility, or a distinct part of a facility, that is certified as a
nursing facility by the director of health in accordance with Title XIX of the
Social Security Act, 49 Stat. 620,
42 U.S.C.
301, as amended (1981), and is not an
intermediate care facility for individuals with intellectual disabilities.
"Nursing facility" includes a facility, or distinct part of a facility, that is
certified as a nursing facility by the director of health in accordance with
Title XIX of the Social Security Act, and is certified as a skilled nursing
facility by the director in accordance with Title XVIII of the Social Security
Act.
(2) "Deficiency" means a
finding cited by the department during a survey conducted under 42 C.F.R. Part
488 (2011), on the basis of one or more actions, practices, situations, or
incidents occurring at a nursing facility.
(3) "Survey" means a survey of a nursing
facility conducted under section
5165.64 of the Revised Code and
under 42 C.F.R. Part 488 (2011).
(4) "Follow-up survey" means a survey
conducted by the department to determine whether a nursing facility has
substantially corrected deficiencies cited in a previous survey.
(5) "Statement of deficiencies" means the
detailed statement prepared by the department under 42 C.F.R. Part 488 (2011)
that sets forth all findings and deficiencies cited on the basis of a
survey.
(6) "Department" means the
department of health.
(B) When delivering a statement of
deficiencies to a nursing facility, the department will do so in
such a manner that the statement is received by the facility no later than one
business day after it is sent.
(C)
Whenever a nursing facility receives a statement of deficiencies, the facility
will
submit to the department for its approval, no later than ten days after receipt
of the statement, a plan of correction for each finding or deficiency cited in
the statement. The plan will describe the actions the facility will take to
correct each finding or deficiency and specify the date by which each finding
or deficiency will be corrected.
In the case of a finding or deficiency that was substantially
corrected before the survey, the plan will describe
the actions the facility took to correct the finding or deficiency and the date
on which it was corrected.
(D) The department will notify the
facility of the right to request informal review of any deficiency cited on the
statement of deficiencies. A facility will not be
afforded an opportunity for an independent informal dispute resolution under
42 C.F.R.
488.331 (2011) for the same deficiency unless
the first informal review conducted under paragraph (E) of this rule was
completed prior to the imposition of a civil money penalty. In the case of a
follow-up survey, the facility may request informal review only of deficiencies
that were cited on the follow-up survey but not on the original survey. The
facility is
not allowed to request informal review of deficiencies cited on the
original survey that were cited as not corrected on the follow-up survey.
(1) The department will notify the
facility of the right to request informal review at the same time that the
department provides the facility with the statement of deficiencies.
(2) The facility will request
informal review, in a manner prescribed by the director, within the time for
submitting the plan of correction, as prescribed by paragraph (C) of this rule.
The request for informal review will include all of the following items:
(a) Identification of the specific
deficiencies for which the facility is requesting review;
(b) A written statement explaining why the
facility believes that the deficiency should not have been cited or a different
severity or scope level for deficiencies constituting immediate jeopardy or
substandard quality of care, as defined under 42 C.F.R. Part 488 (2011), should
have been assigned. The statement may be accompanied by any other documentation
that the facility chooses to submit; and
(c) The name of an individual at the facility
whom the department may contact concerning the request, his or her telephone
number, and the times between 7:45 a.m. and 4:30 p.m. when the individual can
be reached each day.
(E) If informal review is requested in a
timely manner, the review will be conducted in accordance with the following
procedures:
(1) The first informal review
will be
conducted by an employee of the department who did not participate in and was
not directly involved in performing the survey. Within ten working days after
the department receives the request, the department will telephone
the facility's designated contact or, if the contact is unavailable, the
administrator or other person in charge of the facility. In the telephone
conversation, the department will summarize the results of the review.
(2) If the facility is satisfied with the
results of the first informal review, the informal review process
will
conclude. If the informal review results in a determination that one or more
deficiencies should not have been cited or should have been cited under a
different requirement or that a different scope or severity level should have
been assigned, the department will issue a revised page or pages of the statement of
deficiencies reflecting that determination.
(3) A facility that is not satisfied with the
results of a first review may request, in a manner prescribed by the director,
a second informal review of deficiencies that cause the facility to be in
noncompliance as defined in 42 C.F.R. 488.301 (2003). The
facility will request this second review and pay the fee
prescribed under paragraph (F)(1) of this rule within ten days of being
informed of the results of the first review.
(a) If the facility requests a second
informal review under this paragraph, the second review
will be
conducted by either of the following as selected by the facility:
(i) A hearing officer employed by the
department; or
(ii) A hearing
officer included on a list the department will provide the
facility.
(b) Upon
receipt of the fee required under paragraph (F)(1) of this rule, the department
will
assign a hearing officer to the second review. The hearing officer
will
notify the department of the results of the second informal review no later
than thirty days after the hearing officer has been assigned the
review.
(c) After review of the
hearing officer's report, the department will notify the
facility's designated contact person by telephone of the department's final
determination.
(d) Upon receipt of
the fee required under paragraph (F)(2) of this rule, the department
will
update all records relating to the survey to reflect a final determination
that:
(i) Any deficiency should not have been
cited;
(ii) Any deficiency should
have been cited under a different requirement; or
(iii) A different severity or scope should
have been assigned for any deficiency constituting immediate jeopardy or
substandard quality of care.
(F) A facility that requests a second
informal review, under paragraph (E) of this rule, will pay the
following fee in a manner prescribed by the director and this paragraph:
(1) A non-refundable fee of one hundred and
fifty dollars which will be paid in accordance with paragraph (E)(3) of
this rule; and
(2) A fee of
seventy-five dollars per hour for each hour it takes the hearing officer to
complete the review which will be paid within thirty days after the facility
receives the department's invoice.
(G) The department's failure to meet any of
the time frames specified by this rule will not
invalidate any finding or deficiency.
