5111.22 Provider agreement requirements.
5111.22 Provider agreement requirements.
A provider agreement between the department of job and family services and the provider of a nursing facility or intermediate care facility for the mentally retarded shall contain the following provisions:
(A) The department agrees to make payments to the provider, as provided in sections 5111.20 to 5111.33 of the Revised Code, for medicaid-covered services the facility provides to a resident of the facility who is a medicaid recipient. No payment shall be made for the day a medicaid recipient is discharged from the facility.
(B) The provider agrees to:
(1) Maintain eligibility as provided in section 5111.21 of the Revised Code;
(2) Keep records relating to a cost reporting period for the greater of seven years after the cost report is filed or, if the department issues an audit report in accordance with division (B) of section 5111.27 of the Revised Code, six years after all appeal rights relating to the audit report are exhausted;
(3) File reports as required by the department;
(4) Open all records relating to the costs of its services for inspection and audit by the department;
(5) Open its premises for inspection by the department, the department of health, and any other state or local authority having authority to inspect;
(6) Supply to the department such information as it requires concerning the facility’s services to residents who are or are eligible to be medicaid recipients;
(7) Comply with section 5111.31 of the Revised Code.
The provider agreement may contain other provisions that are consistent with law and considered necessary by the department.
A provider agreement shall be effective for no longer than twelve months, except that if federal statute or regulations authorize a longer term, it may be effective for a longer term so authorized. A provider agreement may be renewed only if the facility is certified by the department of health for participation in the medicaid program.
The department of job and family services, in accordance with rules adopted under section 5111.02 of the Revised Code, may elect not to enter into, not to renew, or to terminate a provider agreement when the department determines that such an agreement would not be in the best interests of medicaid recipients or of the state.
Effective Date: 06-26-2003; 07-01-2005