Ohio Administrative Code|Rule 5123-7-04 | Intermediate care facilities for individuals with intellectual disabilities - payment during the Ohio department of medicaid administrative appeals process for termination of a provider agreement.

                                                
(A) Purpose
This rule clarifies conditions under which
		  payment may be made to an intermediate care facility for individuals with
		  intellectual disabilities (ICFIID) during proposed termination and upon
		  termination of the ICFIID's provider agreement by the Ohio department of
		  medicaid.
(B) Payment during the appeals
		  process
When the Ohio department of medicaid is required
		  to provide an adjudicatory hearing pursuant to Chapter 119. of the Revised
		  Code, payment shall continue for medicaid-covered services provided to eligible
		  residents during the appeal of and the proposed termination of an ICFIID's
		  provider agreement. Payment shall not be made under this provision for services
		  rendered on or after the effective date of the issuance of a final order of
		  adjudication pursuant to Chapter 119. of the Revised Code, except as provided
		  in paragraph (C)(1) of this rule.
(C) Payment following termination of
		  provider agreement
(1) Payment may be
			 provided up to thirty calendar days following the effective date of termination
			 of an ICFIID's provider agreement or after an administrative hearing
			 decision that upholds the termination action. Payment will be available if both
			 of the following conditions are met:
(a) Payment is for residents admitted to the ICFIID before
				the effective date of termination; and
(b) The ICFIID cooperates with federal, state, and local
				entities in the effort to transfer residents to other facilities or community
				programs that can meet the residents' needs.
(2) When the Ohio
			 department of medicaid acts under instructions from the United States
			 department of health and human services, payment ends on the termination date
			 specified by that agency.