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 5160-3-04 - Nursing facilities (NFs): payment during the Ohio department of medicaid (ODM) administrative appeals process for denial or termination of a provider agreement
Current through all regulations passed and filed through September 16, 2024
(A) When ODM is required to provide an adjudicatory hearing pursuant to Chapter 119. of the Revised Code, payment shall continue for medicaid-covered services provided to eligible residents during the appeal of, and the proposed termination or non-revalidation of, a nursing facility (NF) provider agreement. Payment shall not be made under this provision for services rendered on or after the effective date of ODM issuance of a final order of adjudication pursuant to Chapter 119. of the Revised Code, except as provided in paragraph (B) of this rule.
(B) Payment may be provided up to thirty days following the effective date of termination or non-revalidation of a NF provider agreement; or after an administrative hearing decision that upholds the ODM termination or non-revalidation action. Payment will be available if both of the following conditions are met:
(C) When ODM acts under instructions from the United States department of health and human services, payment ends on the termination date specified by that agency.
