5111.52 Terminating provider agreements. - Ohio Statutes

5111.52 Terminating provider agreements.

(A) As used in this section:

(1) “Provider agreement” means a contract between the department of job and family services and a nursing facility for the provision of nursing facility services under the medical assistance program.

(2) “Terminating” includes not renewing.

(B) A nursing facility’s participation in the medical assistance program shall be terminated under sections 5111.35 to 5111.62 of the Revised Code as follows:

(1) If the department of job and family services is terminating the facility’s participation, it shall issue an order terminating the facility’s provider agreement.

(2) If the department of health, acting as a contracting agency, is terminating the facility’s participation, it shall issue an order terminating certification of the facility’s compliance with certification requirements. When the department of health terminates certification, the department of job and family services shall terminate the facility’s provider agreement. The department of job and family services is not required to provide an adjudication hearing when it terminates a provider agreement following termination of certification by the department of health.

(3) If a state agency other than the department of health, acting as a contracting agency, is terminating the facility’s participation, it shall notify the department of job and family services, and the department of job and family services shall issue an order terminating the facility’s provider agreement. The contracting agency shall conduct any administrative proceedings concerning the order.

(C) If the following conditions are met, the department of job and family services may make medical assistance payments to a nursing facility for a period not exceeding thirty days after the effective date of termination under sections 5111.35 to 5111.62 of the Revised Code of the facility’s participation in the medical assistance program:

(1) The payments are for medicaid eligible residents admitted to the facility prior to the effective date of the termination;

(2) The provider is making reasonable efforts to transfer medicaid eligible residents to other care settings.

The period during which payments may be made under this division begins on the later of the effective date of the termination or, if the facility has appealed a termination order, the date of issuance of the adjudication order upholding termination.

Effective Date: 07-01-2000