Current through all regulations passed and filed through September 16, 2024
(A) Revalidation is the process that a
provider is required to follow to renew and revalidate its provider agreement.
Provider agreements must be revalidated no later than five years from the
effective date of the original or the last revalidated provider agreement,
whichever is applicable. In the event the center for
medicare and medicaid services (CMS) waives or modifies the deadline, provider
agreement revalidation may be delayed as authorized by the CMS waiver or
modification.
Provider agreements must also be revalidated whenever there is a change in risk
pursuant to
42 C.F.R.
455.450 (as in effect May
October 1,
2020) The revalidation process is as follows:
(1) The Ohio department of medicaid (ODM)
shall send a revalidation notice by ninety days prior to the expiration date of the provider's
timelimited agreement either to the provider's
email or mailing address on file notifying the
provider that it is required to revalidate its agreement.
(2) The revalidation notice shall instruct
the provider what is required to complete the revalidation process. Providers
are expected to meet all conditions for participation as an eligible provider
that are in effect in Chapter 5160-1 of the Administrative Code at the time of
revalidation.
(3) The provider
shall submit all required information before the revalidation deadline date
specified in the revalidation notice including the required fee as specified in
rule 5160-1-17.8 of the
Administrative Code.
(4) A provider
shall not initiate revalidation prior to the receipt of the revalidation
notification sent by ODM. This rule does not negate the requirement that a
provider must properly disclose any changes to its provider agreement in
accordance with rule
5160-1-17.3 of the
Administrative Code. The reporting of changes does not constitute the
initiation of revalidation and remains the provider's responsibility.
(5) When a provider fails to revalidate in
the time and the manner required by ODM, as specified in this rule and in
accordance with the revalidation notice referred to in paragraph (A)(1) of this
rule, ODM shall deny an application for revalidation and terminate the
time-limited provider agreement. The denial and termination will take effect
thirty days after ODM mails a written notice to the provider by regular mail to
the address on file notifying the provider of the decision. ODM shall specify
in the notice the date on which the provider is required to cease operating
under a terminated provider agreement.
(6) If a provider files an application for
revalidation within the time and in the manner required, as specified in this
rule, but the provider agreement expires before ODM acts on the application or
before the effective date of the ODM decision on the application, the provider
may continue operating under the terms of the expired agreement until the
effective date of the ODM decision.
(7) If a provider files an application for
revalidation within the time and in the manner required, as specified in this
rule, but has not been able to obtain a renewal of its licensure,
certification, accreditation, or registration the application may be accepted
and processed by ODM as long as the granting official, board, commission,
department, division, bureau, or other agency of state or federal government
considers the provider in good standing and that its licensure, certification,
accreditation, or registration is still active.
(B) The effective date of a new provider
agreement is the date on which the provider signs the application and meets all
of the federal and state requirements for participation in the medicaid
program. The effective date of a new provider agreement may be made retroactive
for up to twelve months prior to the date of application if the provider was
properly licensed or certified.
(C)
Pursuant to section 5164.38 of the Revised Code, ODM
is not required to afford hearing rights, in accordance with Chapter 119. of
the Revised Code when terminating a timelimited provider agreement due to the
provider's failure to properly file an application for revalidation.
(D) In processing an application for
revalidation, ODM reserves the right to conduct an on-site review at the
provider's facility, place of business, or both, as ODM deems necessary to
ensure program integrity.
