Ohio Code 5165.79 – Terminating provider agreements
(A) As used in this section, “terminating” includes not renewing.
Terms Used In Ohio Code 5165.79
- Provider: means an operator with a provider agreement. See Ohio Code 5165.01
- Provider agreement: means a provider agreement, as defined in section 5164. See Ohio Code 5165.01
- Reasonable: means that a cost is an actual cost that is appropriate and helpful to develop and maintain the operation of patient care facilities and activities, including normal standby costs, and that does not exceed what a prudent buyer pays for a given item or services. See Ohio Code 5165.01
- state: means the state of Ohio. See Ohio Code 1.59
(B) A nursing facility’s participation in the medicaid program shall be terminated under sections 5165.60 to 5165.89 of the Revised Code as follows:
(1) If the department of medicaid 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 medicaid shall terminate the facility’s provider agreement. The department of medicaid 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 medicaid, and the department of medicaid 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 medicaid may make medicaid payments to a nursing facility for a period not exceeding thirty days after the effective date of termination under sections 5165.60 to 5165.89 of the Revised Code of the facility’s participation in the medicaid 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.