Ohio Code 5165.42 – Additional penalties
In addition to the other penalties authorized by this chapter, the department of medicaid may impose the following penalties on a nursing facility provider:
Terms Used In Ohio Code 5165.42
- Change of operator: includes circumstances in which an entering operator becomes the operator of a nursing facility in the place of the exiting operator or there is a change in owner of a nursing facility. See Ohio Code 5165.01
- Entering operator: means the person or government entity that will become the operator of a nursing facility when a change of operator occurs or following an involuntary termination. See Ohio Code 5165.01
- Exiting operator: means any of the following:
(1) An operator that will cease to be the operator of a nursing facility on the effective date of a change of operator;
(2) An operator that will cease to be the operator of a nursing facility on the effective date of a facility closure;
(3) An operator of a nursing facility that is undergoing or has undergone a voluntary withdrawal of participation;
(4) An operator of a nursing facility that is undergoing or has undergone an involuntary termination. See Ohio Code 5165.01
- facility closure: means either of the following:
(a) Discontinuance of the use of the building, or part of the building, that houses the facility as a nursing facility that results in the relocation of all of the nursing facility's residents;
(b) Conversion of the building, or part of the building, that houses a nursing facility to a different use with any necessary license or other approval needed for that use being obtained and one or more of the nursing facility's residents remaining in the building, or part of the building, to receive services under the new use. See Ohio Code 5165.01
- Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
- Operator: means the person or government entity responsible for the daily operating and management decisions for a nursing facility. See Ohio Code 5165.01
- Owner: means any person or government entity that has at least five per cent ownership or interest, either directly, indirectly, or in any combination, in any of the following regarding a nursing facility:
(a) The land on which the nursing facility is located;
(b) The structure in which the nursing facility is located;
(c) Any mortgage, contract for deed, or other obligation secured in whole or in part by the land or structure on or in which the nursing facility is located;
(d) Any lease or sublease of the land or structure on or in which the nursing facility is located. See Ohio Code 5165.01
- Provider: means an operator with a provider agreement. See Ohio Code 5165.01
- state: means the state of Ohio. See Ohio Code 1.59
- Voluntary withdrawal of participation: means an operator's voluntary election to terminate the participation of a nursing facility in the medicaid program but to continue to provide service of the type provided by a nursing facility. See Ohio Code 5165.01
(A) If the provider does not furnish invoices or other documentation that the department requests during an audit within sixty days after the request, a fine of no more than the greater of the following:
(1) One thousand dollars per audit;
(2) Twenty-five per cent of the cumulative amount by which the costs for which documentation was not furnished increased the total medicaid payments to the provider during the state fiscal year for which the costs were used to determine a rate.
(B) If an exiting operator or owner fails to provide notice of a facility closure or voluntary withdrawal of participation in the medicaid program as required by section 5165.50 of the Revised Code, or an exiting operator or owner and entering operator fail to provide notice of a change of operator as required by section 5165.51 of the Revised Code, a fine of not more than the current average bank prime rate plus four per cent of the last two monthly payments.