Current through Vol. 42, No. 1, September 16, 2024
(a)
Nursing
home license required. A NF must meet state nursing home licensing
standards to provide, on a regular basis, health related care and services to
individuals who do not require hospital care.
(1) In order for long term care facilities to
receive payment from the OHCA for the provision of nursing care, they must be
currently licensed under provisions of Title 63 O.S., Nursing Home Care Act,
Section
1-1900.1,
et seq.
(2) The State Department
of Health is responsible for the issuance, renewal, suspension , and revocation
of a facility's license in addition to the enforcement of the standards. The
denial, suspension , or revocation of a facility's license is subject to appeal
to the State Department of Health. All questions regarding a facility's license
should be directed to the State Department of Health.
(b)
Certification survey. The
State Department of Health is designated as the State Survey Agency and is
responsible for determining a long term care facility's compliance with Title
XIX requirements. The results of the survey are forwarded to the OHCA by the
State Survey Agency.
(c)
Certification period. The certification period of a long term care
facility is determined by the State Survey Agency. In the event the facility's
deficiencies are found to be of such serious nature as to jeopardize the health
and safety of the member, the State Survey Agency may terminate (de-certify)
the facility's certification period and notify the OHCA . Upon notification by
the State Survey Agency, the OHCA will notify the facility by certified letter
that the contract is being terminated. The letter will indicate the effective
date and specify the time period that payment may continue in order to allow
orderly relocation of the members . The decision to terminate a facility's
certification by the State Survey Agency is subject to appeal to the State
Department of Health.
(d)
Certification with deficiencies. Certification of any facility
that has been found to have deficiencies by the State Survey Agency will be
governed by
42
CFR 442.110 (certification period for ICF/IID
with standard-level deficiencies) or
42
CFR 442.117 (termination of certification for
ICFs/IID whose deficiencies pose immediate jeopardy).
(e)
Contract
procedures.
(1) A facility
participating in the Medicaid program will be notified by the OHCA 75 days
prior to the expiration of the existing contract . The facility must complete a
new contract to continue participation in the SoonerCare program.
(2) When the contract is received, approved
by the OHCA , and the HCFA-1539 has been received from the State Department of
Health indicating the facility's certification period, the contract will be
completed.
(3) Intermediate care
facilities for individuals with intellectual disabilities(ICF/IID) wishing to
participate in the ICF/IID program must be approved and certified by the State
Survey Agency as being in compliance with the ICF/IID regulations ( 42 CFR 442
Subpart C). It is the responsibility of a facility to request the State Survey
Agency perform a survey of compliance with ICF/IID regulations.
(A) When the OHCA has received notification
of a facility's approval as an ICF/IID and the Title XIX survey of compliance
has begun, the contract will be sent to the facility for completion.
(B) A facility which has been certified as an
ICF/IID and has a contract with the OHCA will be paid only for members that
have been approved for ICF/IID level of care. When the facility is originally
certified to provide ICF/IID services, payment for member's currently residing
in the facility who are approved for a NF level of care will be made if such
care is appropriate to the member's needs.
(f)
New facilities. Any new
facility in Oklahoma must receive a Certificate of Need from the State
Department of Health. It is the responsibility of the new facility to request
the State Survey Agency to perform a survey for Title XIX compliance.
(1) When construction of a new facility is
completed and licensure and certification is imminent, facilities wishing to
participate in the Title XIX Medicaid Program may apply electronically to
become a Medicaid contracted provider.
(2) In no case can payment be made for any
period prior to the effective date of the facility's certification.
(g)
Change of
ownership. The acquisition of a facility operation, either whole or in
part, by lease or purchase, or if a new Federal Employer Identification Number
is required, constitutes a change of ownership. The new owner must follow
provisions of the Nursing Home Care Act at Title 63 O.S. Section
1-1905(D)
(relating to transfers in ownership) and OAC
310:675-3-8
(relating to notice of change), as applicable. When such change occurs, it is
necessary that a new contract be completed between the new owner and the OHCA
in order that payment can continue for the provision of nursing care.
(1)
License changes due to change of
ownership. State Law prescribes specific requirements regarding the
transfer of ownership of a NF from one person to another. When a transfer of
ownership is contemplated, the buyer/seller or lessee/lessor must notify the
State Department of Health prior to the final transfer and apply for a new
facility license.
(2)
Certificate of Need. A change of ownership is subject to review by
the State Department of Health. Any person contemplating the acquisition of a
NFshould contact the State Department of Health for further information
regarding Certificate of Need requirements.
(A) The new owner must obtain a Certificate
of Need as well as a new facility license from the State Department of Health.
Pending notification of licensure, no changes will be made to the OHCA's
facility records with the exception of change in administrator or change in
name, if applicable.
(B) When a
change in ownership does occur, the OHCA will automatically assign the contract
to the new owner per federal regulation. By signing the contract, the new owner
is representing to the OHCA that they meet the requirements of the contract and
the requirements for participation in the Medicaid program. The new owner's
contract is subject to the prior owner's contract terms and conditions that
were in effect at the time of transfer of ownership, including compliance with
all appropriate federal regulations.
(h) A nursing facility or ICF/IID
dissatisfied with an action taken by the OHCA that is appealable as a matter of
right pursuant to Subpart D of Part 431 of Title 42 of the Code of Federal
Regulations, shall be afforded a hearing as provided by
42 CFR
431.153 or
431.154.
Added at 12 Ok Reg
751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff
7-27-95; Amended at 14 Ok Reg 265, eff 9-17-96 (emergency); Amended at 14 Ok
Reg 1780, eff 5-27-97; Amended at 23 Ok Reg 771, eff 3-9-06 (emergency);
Amended at 23 Ok Reg 2440, eff 6-25-06
