Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-3 - Long-Term Care Facilities; Nursing Facilities; Intermediate Care Facilities for the Individuals with Intellectual Disabilities
Section 5160-3-02.1 - Nursing facilities (NFs): length and type of provider agreements
Universal Citation: OH Admin Code 5160-3-02.1
Current through all regulations passed and filed through September 16, 2024
(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 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
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
medicaid (ODM).
(B) Effective dates .
(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 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,
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 .
(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 term of a
NF or SNF/NF provider agreement shall be
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.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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