Ohio Admin. Code 5160-1-17.7 - Application by a former participating medicaid provider to resume participation in the Ohio medicaid program [except for medicaid contracting managed care plans (MCPs)]
(A) An individual or entity that at one time
was a participating provider in the Ohio medicaid program and whose provider
agreement was terminated either voluntarily or involuntarily in accordance with
rule 5101:3-1- 17.6
5160-1- 17.6 of the Administrative Code must complete
a new application for enrollment if that individual or entity wants to resume
participation in the Ohio medicaid program.
(B) In considering an application for
participation in the Ohio medicaid program by a former medicaid provider
described in paragraph (A) of this rule, and except as provided by paragraphs
(C) and (D) of this rule, the Ohio department of job
and family services
medicaid (ODJFS
ODM ) may grant
the application only if it is reasonably certain that the types of actions that
formed the basis for termination or exclusion have not recurred and will not
recur. In making this determination, ODJFS
ODM will
consider, in addition to any factors set forth in state law:
(1) The conduct of the former medicaid
provider from the date the provider's previous provider agreement was
terminated;
(2) Whether all fines,
and all debts due and owing, including overpayments, to any federal, state or
local government that relate to any of the state health care programs, have
been paid, or satisfactory arrangements have been made, that fulfill these
obligations; and
(3) Whether all
requirements for participation are met at the time of the application filed
pursuant to paragraph (A) of this rule, as evidenced by all appropriate and
required documentation submitted with the application by the former medicaid
provider.
(C)
Notwithstanding paragraph (B) of this rule, ODFJS
ODM shall deny
the application of a former medicaid provider whose provider agreement was
terminated under paragraph (F)(4) or (F)(6)
(I)(4) or (I)(6) of rule
5101:3-1- 17.6
5160-1- 17.6 of the Administrative Code.
(D) In the case of a former medicaid provider
that allowed its provider agreement to lapse by failing to timely
renew
revalidate its provider agreement, and whose provider
agreement has been inactive for at least sixty days, ODJFS
ODM may, without
regard to the criteria set forth in paragraph (B) of this rule and at its
discretion, grant an application that demonstrates through all appropriate and
required documentation that the requirements to participate as a medicaid
provider are met at the time the application is filed.
(E) If ODJFS
ODM approves an
application filed under paragraph (A) of this rule, it must give written notice
to the applicant specifying the date on which participation in the Ohio
medicaid program may resume. The notice shall specify whether the applicant is
assigned its former provider number or a new provider number, the determination
of which shall be in the sole discretion of ODJFS
ODM .
(F) If ODJFS
ODM does not
approve an application filed under paragraph (A) of this rule, it must give the
applicant written notice of that decision. The notice will provide review
rights in accordance with paragraph (D) of rule
5101:3-1-57
5160-70-02 of the Administrative Code.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5162.03, 5164.02
Prior Effective Dates: 12/19/2009
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