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

 

 

 

5160-3-02.1                 Nursing facilities (NFs): Length length and type of long term care provider agreements.

 

 

 

(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 long term carenursing 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 long term care 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 job and family services (ODJFS)medicaid (ODM).

 

(B)     Effective  dates  -  skilled  nursing  facilities  (SNFs),  nursing  facilities  (NFs),  and SNF/NFs.

 

(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 institutionfacility.

 

(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, ODJFS 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 - NFs and SNF/NFs.

(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

(1)(2) The term of a NF or SNF/NF provider agreement shall be based ondetermined 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.

(2) The actual term of the agreement may be less than, but shall not exceed, the certification period recommended by the state survey agency.

(3) NFs and SNF/NFs.

(a) NFs and SNF/NFs are governed by open-end provider agreements.

(b) Open-end agreements have no specific expiration date.

(c) Continuation of an open-end provider agreement is contingent upon findings of continued compliance or substantial compliance with certification standards as determined by the state survey agency.

Effective:                                                             06/24/2016

Five Year Review (FYR) Dates:                         03/04/2016 and 06/24/2021

CERTIFIED ELECTRONICALLY

Certification

06/14/2016

Date

Promulgated Under:                           119.03

Statutory Authority:                           5164.02

Rule Amplifies:                                  5164.32

Prior Effective Dates:                         4/4/77, 12/30/77, 1/1/79, 3/23/79, 8/31/79, 11/1/79,

7/1/80, 7/7/80, 10/1/87, 1/1/95, 5/16/02, 9/29/05,

2/15/11, 1/10/13