3701-63-01 Medicaid certification appeal process.  

  • Text Box: ACTION: Revised Text Box: DATE: 09/26/2016 11:17 AM

     

     

     

    Rule Summary and Fiscal Analysis (Part A)

     

    Department of Health

    Agency Name

     

    Kaye Norton

    Division                                                                  Contact

     

    246 North High Street Columbus OH 43215-0000

    Agency Mailing Address (Plus Zip)

    614-644-8184

    Phone

     

    Fax

    Kaye.Norton@odh.ohio.gov

    Email

     

     

     

     

    3701-63-01

    Rule Number

    AMENDMENT

    TYPE of rule filing

    Rule Title/Tag Line              Medicaid certification appeal process.

    RULE SUMMARY

    1.  Is the rule being filed for five year review (FYR)? Yes

    2.  Are you proposing this rule as a result of recent legislation? No

    3.  Statute prescribing the procedure in accordance with the agency is required to adopt the rule: 119.03

    4.  Statute(s) authorizing agency to adopt the rule: 3721.022

    5.  Statute(s) the rule, as filed, amplifies or implements: 3721.022

    6.  State the reason(s) for proposing (i.e., why are you filing,) this rule:

    This rule has been reviewed to satisfy five-year review requirements, and is being proposed with amendments.

    7.  If the rule is an AMENDMENT, then summarize the changes and the content of the proposed rule; If the rule type is RESCISSION, NEW or NO CHANGE, then summarize the content of the rule:

    This rule sets forth the procedure for appeal of proposals by the director of health to

    deny, terminate, or not renew a long-term care facility's certification as an intermediate care facility or an intermediate care facility for individuals with intellectual disabilities for the purposes of participation in the Medicaid program established by Title XIX of the Social Security Act.

    The rule has been amended to replace the term "mental retardation" with individuals with intellectual disabilities" and to update a cross citation.

    8.  If the rule incorporates a text or other material by reference and the agency claims the incorporation by reference is exempt from compliance with sections

    121.71 to 121.74 of the Revised Code because the text or other material is generally available to persons who reasonably can be expected to be affected by the rule, provide an explanation of how the text or other material is generally available to those persons:

    This rule references the Ohio Revised and Administrative Codes, The Social Security Act, and CMS Form 2567. The O.R.C. and O.A.C., the Social Security Act, and the CMS form are available in libraries and on the internet to persons who reasonably can be expected to be affected by the form.

    9.  If the rule incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material electronically, provide an explanation of why filing the text or other material electronically was infeasible:

    The cited materials are exempted from inclusion in this filing pursuant to R.C.

    121.75 and 121.76.

    10.  If the rule is being rescinded and incorporates a text or other material by reference, and it was infeasible for the agency to file the text or other material, provide an explanation of why filing the text or other material was infeasible:

    Not Applicable.

    11.  If revising or refiling this rule, identify changes made from the previously filed version of this rule; if none, please state so. If applicable, indicate each specific paragraph of the rule that has been modified:

    9/26/2016 - This rule is revise filed to correct the authorizing statute.

    12.  Five Year Review (FYR) Date: 9/9/2016

    (If the rule is not exempt and you answered NO to question No. 1, provide the

    scheduled review date. If you answered YES to No. 1, the review date for this rule is the filing date.)

    NOTE: If the rule is not exempt at the time of final filing, two dates are required: the current review date plus a date not to exceed 5 years from the effective date for Amended rules or a date not to exceed 5 years from the review date for No Change rules.

    FISCAL ANALYSIS

    13.  Estimate the total amount by which this proposed rule would increase / decrease either revenues / expenditures for the agency during the current biennium (in dollars): Explain the net impact of the proposed changes to the budget of your agency/department.

    This will have no impact on revenues or expenditures.

    $0.00

    Not applicable

    14.  Identify the appropriation (by line item etc.) that authorizes each expenditure necessitated by the proposed rule:

    Not applicable

    15.  Provide a summary of the estimated cost of compliance with the rule to all directly affected persons. When appropriate, please include the source for your information/estimated costs, e.g. industry, CFR, internal/agency:

    Not applicable

    16.  Does this rule have a fiscal effect on school districts, counties, townships, or municipal corporations? No

    17.  Does this rule deal with environmental protection or contain a component dealing with environmental protection as defined in R. C. 121.39? No

    S.B. 2 (129th General Assembly) Questions

    18.  Has this rule been filed with the Common Sense Initiative Office pursuant to

    R.C. 121.82? Yes

    19.  Specific to this rule, answer the following:

    A.) Does this rule require a license, permit, or any other prior authorization to engage in or operate a line of business? No

    While this rule does not require a license, all long-term care facilities are required to be licensed before they are certified for participation in the Medicaid program and intermediate care facilities for individuals with intellectual disabilities are certified for participation in the Medicaid program.

    B.) Does this rule impose a criminal penalty, a civil penalty, or another sanction, or create a cause of action, for failure to comply with its terms? No

    The rule sets forth hearing rights for certified facilities. This could result in denial, termination, or non-renewal of a facility's participation in the Medicaid program.

    C.) Does this rule require specific expenditures or the report of information as a condition of compliance? No

    If the director of health offers, and the facility accepts, an opportunity for informal reconsideration of a finding, the facility would need to submit documentation to support its position.

Document Information

File Date:
2016-09-26
Five Year Review:
Yes
CSI:
Yes
Rule File:
3701-63-01_PH_RV_A_RU_20160926_1117.pdf
RSFA File:
3701-63-01_PH_RV_A_RS_20160926_1117.pdf
Related Chapter/Rule NO.: (1)
Ill. Adm. Code 3701-63-01. Medicaid certification appeal process