Chapter 514 - Nursing Facility Services - DHHR - State of West ...

The Commissioner, in his or her discretion, shall determine whether to approve or deny therequest of Medicaid reimbursement for the transfer or dual certification of currently licensedbeds. In determining whether or not to approve the requests for dual certification or ontransferred beds, the Commissioner shall take into consideration the fiscal impact of therequest as well as the need for the transferred or dual certified beds as stated by the request.514.2.8 Non-Compliance of Nursing FacilitiesOHFLAC conducts surveys on all nursing facilities for compliance or noncompliance with therequirements for long term care nursing facilities. When OHFLAC completes a survey, CMSmay follow up with a validation survey. A determination is final except in the case of a complaintor validation survey conducted by the CMS.Under Federal guidelines, OHFLAC certifies the compliance or noncompliance of a non-Stateoperated skilled nursing facility. OHFLAC also certifies compliance or noncompliance for adually participating skilled nursing facility/nursing facility. If there is a disagreement betweenCMS and OHFLAC, CMS’s determination as to the facility’s noncompliance is binding and takesprecedence over a determination of compliance by OHFLAC (see 42 CFR 488.330 (a)).A certification of compliance constitutes a determination that the facility is in substantialcompliance and is eligible to participate in Medicaid as a Nursing Facility, or in Medicare as aSkilled Nursing Facility, or in Medicare and Medicaid as a dually participating facility.A certification of noncompliance requires denial of participation for prospective providers andenforcement action for current providers in accordance with Federal guidelines. Enforcementaction must include either termination of the Medicaid provider agreement or the application ofalternative remedies instead of, or in addition to, termination procedures. In cases where eitherBMS or CMS is taking action, notice of noncompliance resulting in action will be sent inaccordance with 42 CFR 488.402 (f).Termination of a provider agreement with a nursing facility may result from, but not be limited to,any of the following:1. Failure to comply with licensure and certification standards as identified by OHFLAC andCMS;2. Failure to implement the corrective action plan accepted by OHFLAC and CMS forcorrection of non-compliance with license and certification standards; or3. Failure to comply with all of the provisions of the provider agreement executed withBMS.4. Exclusion Proceedings – See Common Chapter 300, Provider ParticipationRequirements.When an agreement is terminated, Medicaid may continue reimbursement to the nursing facilityfor a period not to exceed 30 days from the date of termination. The 30 day continuation is onlyfor Medicaid members admitted to the nursing facility prior to the date of termination of theprovider agreement. It is the responsibility of the governing body or designee of the nursingDepartment of Health and Human Resources Chapter 514: Nursing Facility Services Page 16January 1, 2013DISCLAIMER: This manual does not address all the complexities of Medicaid policies and procedures,and must be supplemented with all State and Federal Laws and Regulations.