5160-3-02.1 Length and type of long-term care provider agreements.  

  • Text Box: ACTION: Original Text Box: DATE: 03/04/2016 10:05 AM

     

    PUBLIC HEARING NOTICE OHIO DEPARTMENT OF MEDICAID

     

    DATE:                                     April 4, 2016

    TIME:                                      11:30 a.m.

    LOCATION:                           Room A401, Lazarus Building

    50 W. Town St., Columbus, OH 43215

     

    Pursuant to section 5165.02 and Chapter 119. of the Ohio Revised Code, the director of the Ohio Department of Medicaid gives notice of the department's intent to consider the adoption, amendment, or rescission of the rule or rules as identified below and of a public hearing thereon.

     

    Proposed for Amendment

     

    Rule 5160-3-02, entitled "Nursing facilities (NFs): provider agreements" sets forth provisions for the execution and maintenance of a provider agreement between the Ohio Department of Medicaid and a nursing facility operator. This rule was reviewed pursuant to a five-year rule review. As a result of that review, this rule is being proposed for amendment. The changes to the rule are:

    ·         The rule title is being modified in order to be consistent with the titles of other nursing facility rules in Chapter 5160-3 of the Administrative Code.

    ·         Language is being added in the opening paragraph to clarify that the execution and maintenance of a nursing facility provider agreement is contingent upon the provider agreement provisions in Chapters 5164. and 5165. of the Revised Code.

    ·         In paragraph (A)(1)(c), a reference to the Social Security Act is being modified and a date is being added in order to comply with Joint Commission on Agency Rule Review (JCARR) rule filing requirements.

    ·         In paragraphs (A)(2) and (B)(8)(c)(iv), the term "life care" is being added as another name for the type of living setting defined as "continuing care" in order to reflect current terminology.

    ·         In paragraph (B)(8), the threshold at which the provisions in this paragraph apply is being changed from "only if less than eighty per cent of the total residents in the NF are recipients of medicaid" to "unless at least twenty-five per cent of the NF's medicaid certified beds are occupied by medicaid recipients at the time the individual would otherwise be admitted" in order to comply with section 5165.08 of the Revised Code.

    ·         In paragraph (B)(9)(a), the form date is being updated to reflect the version in effect on the date of filing this rule.

    ·         Paragraph (B)(9)(b) is being deleted because the provision in it applies to dates of service prior to July 1, 2005. In new paragraph (B)(9)(b), the reference to dates of service on or after July 1, 2005 is being deleted because it is no longer necessary.

    ·         In paragraph (B)(13), United States Code citations are being added to references to the Civil Rights Act and the Americans with Disabilities Act, and dates are being added in order to comply with JCARR rule filing requirements.

    ·         In paragraph (B)(14), addresses are being updated for the Ohio Department of Medicaid's Office of Legal Services and the Ohio Office of the Attorney General to reflect current locations.

     

     

     

     

    ·         Paragraph (C) is being deleted, and the provisions in it are being moved to paragraph (B), because both paragraphs (B) and (C) are listings of provisions with which a nursing facility provider shall comply in order to execute and maintain a provider agreement.

    ·         In paragraph (D)(3), language is being updated that specifies the access to electronic information the Department of Medicaid provides to nursing facility providers when rules are filed under section 119.03 or 111.15 of the Revised Code.

    ·         In paragraph (E), the term "renew" is being replaced with the term "revalidate" in order to be consistent with terminology used in Chapters 5164. and 5165. of the Revised Code.

    ·         Ohio Administrative Code references are being updated due to the creation of the  Ohio Department of Medicaid by Am. Sub. HB 59 of the 130th General Assembly and the subsequent renumbering of rules by the Legislative Services Commission.

    ·         Ohio Revised Code citations are being updated because Am. Sub. HB 59 of the 130th General Assembly created the Ohio Department of Medicaid, and subsequently relocated and reorganized many Revised Code provisions governing the Medicaid program.

    ·         The Department's name is being updated from the Ohio Department of Job and  Family Services (ODJFS) to the Ohio Department of Medicaid (ODM) because of the creation of the Ohio Department of Medicaids.

    ·         Phrasing and grammatical changes are being made throughout the rule to improve clarity, comprehension, and readability.

    ·         Paragraph references are being updated as necessary.

    Rule 5160-3-02.1, entitled "Nursing facilities (NFs): length and type of provider agreements" sets forth provisions for effective dates, term limits, and the revalidation process for provider agreements for nursing facility operators. This rule was reviewed pursuant to a five-year rule review. As a result of that review, this rule is being proposed for amendment. The changes to the rule are:

    ·         The rule title is being modified in order to be consistent with the titles of other nursing facility rules in Chapter 5160-3 of the Administrative Code.

    ·         The Department's name is being updated from the Ohio Department of Job and  Family Services (ODJFS) to the Ohio Department of Medicaid (ODM) because of the creation of the Ohio Department of Medicaid.

    ·         In paragraphs (B) and (C), the paragraph headings are being modified to improve readability.

    ·         In paragraph (C), language is being changed to require nursing facility provider agreements to be revalidated at least every five years in accordance with section

    5164.32 of the Revised Code.

    ·         In paragraph (C)(1), language is being added to direct the reader to rule 5160-1-17.4 of the Administrative Code for the revalidation process for nursing facilities.

    ·         Phrasing changes and additions are being made throughout the rule to improve clarity, comprehension, and readability.

    ·         Paragraph references are being updated as necessary.

    Rule 5160-3-02.2, entitled "Nursing facilities (NFs): termination, denial, and non- revalidation of provider agreements" sets forth provisions regarding the termination, denial, and non-revalidation of provider agreements for nursing facility operators. This rule was reviewed pursuant to a five-year rule review. As a result of that review, this rule is being

    proposed for amendment. The changes to the rule are:

    ·         The rule title is being modified in order to be consistent with the titles of other nursing facility rules in Chapter 5160-3 of the Administrative Code.

    ·         The term "renew" is being replaced with the term "revalidate" throughout the rule in order to be consistent with terminology used in Chapters 5164. and 5165. of the Revised Code.

    ·         In paragraph (B)(2)(g), United States Code citations and dates are being added to references to the Rehabilitation Act of 1973, the Civil Rights Act of 1964, and the Americans with Disabilities Act of 1990 in order to comply with Joint Commission on Agency Rule Review (JCARR) rule filing requirements.

    ·         In paragraph (B)(2)(i), in order to make provisions consistent with statutory requirements, language is being updated to prohibit a nursing facility provider from requesting a resident to share in the cost of covered services through deductibles, coinsurance, co-payments, or other similar charges, other than Medicaid co-payments as defined in rule 5160-1-09 of the Administrative Code. Also in this paragraph, language regarding the prohibition against factoring is being deleted because it is obsolete.

    ·         The provision in paragraph (B)(2)(k) is being updated and moved to new paragraph (C)(2)(c) because it is a reason for mandatory termination of the Medicaid provider agreement in accordance with section 5165.073 of the Revised Code.

    ·         Paragraph (C) is being restructured to improve clarity and comprehension. New paragraph (C)(1) lists only the reasons not specified in the Revised Code or the Administrative Code for which the Department of Medicaid shall terminate, deny, or not revalidate a nursing facility provider agreement. New paragraph (C)(2) is being restructured to include only reasons set forth in the Revised Code and in the Administrative Code for which the Department of Medicaid shall terminate, deny, or not revalidate a nursing facility provider agreement. In addition, language in paragraph (C)(2) regarding termination, denial, or non-revalidation for situations set forth in division (D) of section 5111.06 of the Revised Code is being deleted because it is obsolete.

    ·         The language in new paragraph (C)(2)(a) regarding conviction of, or the entry of a judgment in either a criminal or civil action against the provider or its owner, officer, authorized agent, associate, manager, or employee in an action brought pursuant to section 109.85 of the Revised Code is being rephrased to mirror the language in section 5164.35 of the Revised Code.

    ·         In new paragraph (C)(2)(d), a nursing facility provider for which any of the scenarios specified under division (B) of section 5165.771 of the Revised Code apply is being added in as a reason for termination of the Medicaid provider agreement in order to make the provision consistent with statutory requirements.

    ·         In new paragraph (C)(2)(e), failure by a nursing facility provider to file a cost report required by section 5165.10 of the Revised Code is being added as a reason for termination of the Medicaid provider agreement in order to make the provision consistent with statutory requirements.

    ·         In new paragraph (C)(2)(g), failure by a nursing facility provider to maintain eligibility for a provider agreement as set forth in section 5165.06 of the Revised Code is being added as a reason for non-revalidation of the Medicaid provider agreement in order to make the provision consistent with statutory requirements.

    ·         In new paragraph (C)(2)(h), failure by a nursing facility provider to file a complete application for revalidation within the time and in the manner required by the

    revalidation process specified by the Department of Medicaid is being added as a reason for non-revalidation of the Medicaid provider agreement in order to make the provision consistent with statutory requirements.

    ·         In paragraph (D)(1), a reference to paragraph (C) of this rule is being corrected to properly reference division (E) of ORC section 5164.38.

    ·         In paragraph (E), the citation for the State Operations Manual is being updated and the Code of Federal Regulations citation is being dated to comply with JCARR rule filing requirements.

    ·         Paragraph (E)(4) regarding certification of noncompliance is being deleted because it is no longer necessary.

    ·         Ohio Revised Code citations are being updated because Am. Sub. HB 59 of the 130th General Assembly created the Ohio Department of Medicaid, and subsequently relocated and reorganized many Revised Code provisions governing the Medicaid program.

    ·         Ohio Administrative Code references are being updated due to the creation of the  Ohio Department of Medicaid by Am. Sub. HB 59 of the 130th General Assembly and the subsequent renumbering of rules by the Legislative Services Commission.

    ·         The Department's name is being updated from the Ohio Department of Job and  Family Services (ODJFS) to the Ohio Department of Medicaid (ODM) because of the creation of the Ohio Department of Medicaid.

    ·         Phrasing changes are being made throughout the rule to improve clarity, comprehension, and readability.

    ·         Paragraph references are being updated as necessary.

    Rule 5160-3-02.3, entitled "Nursing facilities (NF): institutions eligible to participate in medicaid as NFs" sets forth the eligibility provisions for institutions to participate in the Medicaid program as nursing facilities. This rule was reviewed pursuant to a five-year rule review. As a result of that review, this rule is being proposed for amendment. The changes to the rule are:

    ·         The rule title is being modified in order to be consistent with the titles of other nursing facility rules in Chapter 5160-3 of the Administrative Code.

    ·         The Department's name is being updated from the Ohio Department of Job and  Family Services (ODJFS) to the Ohio Department of Medicaid (ODM) because of the creation of the Ohio Department of Medicaid.

    ·         In paragraph (A)(1), the United States Code citation is being added to the reference to the Social Security Act and a date is being added in order to comply with Joint Commission on Agency Rule Review (JCARR) rule filing requirements.

    ·         In paragraph (A)(3), the reference to "intermediate care facility for the mentally retarded (ICF-MR) services" is being deleted because it is not relevant to this rule.

    ·         Dates are being added to Code of Federal Regulations (C.F.R.) citations throughout the rule in order to comply with Joint Commission on Agency Rule Review (JCARR) rule filing requirements.

    ·         In paragraph (A)(9), the name of the Ohio Department of Health is being spelled out in order to comply with Legislative Services Commission (LSC) rule filing guidelines.

    ·         In paragraph (A)(10), a date is being added to the United States Code citation and to the Code of Federal Regulations citation in order to comply with Joint Commission on Agency Rule Review (JCARR) rule filing requirements.

    ·         In paragraph (C)(3), the reference to the Department of Medicaid's nursing facility

    provider agreement form, the ODM 03623, is being updated to reflect the version in effect on the date of filing this rule.

    ·         In paragraph (D)(4), the citation to rule 3701-59-01 of the Administrative Code regarding the definition of long term care beds is being updated to a citation to section 3702.51 of the Revised Code.

    ·         In paragraph (E), section 5165.082 of the Revised Code is being added as a citation to identify the statutory requirement regarding mandatory participation by Ohio nursing facilities in the Medicare program.

    ·         Ohio Administrative Code references are being updated due to the creation of the  Ohio Department of Medicaid by Am. Sub. HB 59 of the 130th General Assembly and the subsequent renumbering of rules by the Legislative Services Commission.

    ·         Ohio Revised Code citations are being updated because Am. Sub. HB 59 of the 130th General Assembly created the Ohio Department of Medicaid, and subsequently relocated and reorganized many Revised Code provisions governing the Medicaid program.

    ·         Phrasing and grammatical changes are being made throughout the rule to improve clarity, comprehension, and readability.

    Rule 5160-3-02.4, entitled "Nursing facilities (NF): mandatory dual participation in the medicare program" sets forth the provisions for the mandatory participation of Ohio nursing facilities in the Medicare program. This rule was reviewed pursuant to a five-year rule review. As a result of that review, this rule is being proposed for amendment. The changes to the rule are:

    ·         The rule title is being modified in order to be consistent with the titles of other nursing facility rules in Chapter 5160-3 of the Administrative Code.

    ·         Paragraph headings are being modified for brevity and clarity.

    ·         In paragraph (A)(1), the term "distinct part" is being deleted because it is not being used in this rule.

    ·         In paragraph (B)(1), a citation to section 5165.082 of the Revised Code is being added to the requirement for mandatory participation by Ohio nursing facilities in the Medicare program because this statute also requires Ohio nursing facilities to participate in the Medicare program.

    ·         The provision in paragraph (B)(2)(c) regarding out-of-state providers is being clarified, and the provision regarding hospital beds re-categorized as skilled nursing beds is being clarified and moved to new paragraph (B)(2)(d) to improve readability.

    ·         In paragraph (C)(2), the term "renew" is being replaced with the term "revalidate" and in paragraph (E)(3), "renewal" is being replaced with "revalidation" in order to be consistent with terminology used in Chapters 5164. and 5165. of the Revised Code.

    ·         The Department's name is being updated from the Ohio Department of Job and  Family Services (ODJFS) to the Ohio Department of Medicaid (ODM) because of the creation of the Ohio Department of Medicaid.

    ·         Ohio Administrative Code references are being updated due to the creation of the Ohio Department of Medicaid by Am. Sub. HB 59 of the 130th General Assembly and the subsequent renumbering of rules by the Legislative Services Commission.

    A copy of the proposed rule(s) is available, without charge, to any person affected by the rule(s) at the address listed below. The rule(s) is also available on the internet at  http://www.registerofohio.state.oh.us/. A public hearing on the proposed rule(s) will be held

    at the date, time, and location listed at the top of this notice. Either written or oral testimony will be taken at the public hearing. Additionally, written comments submitted or postmarked no later than the date of the public hearing will be treated as testimony.

    Requests for a copy of the proposed rule(s) or comments on the rule(s) should be submitted by mail to the Ohio Department of Medicaid, Office of Legal Counsel, 50 W. Town Street, 4th Floor, Columbus, Ohio 43215-3414, by fax at (614) 995-1301, or by e-mail at  Rules@Medicaid.Ohio.gov. Testimony received may be reviewed at this address.