Ohio Administrative Code › Title 5160 - Ohio Department of Medicaid › Chapter 5160-1 - General Provisions › Section 5160-1-17.4 - Revalidation of provider agreements

Current through all regulations passed and filed through July 1, 2024
(A) Revalidation is the process that a
			 provider is required to follow to renew and revalidate its provider agreement.
			 Provider agreements must be revalidated no later than five years from the
			 effective date of the original or the last revalidated provider agreement,
			 whichever is applicable. In the event the center for
			 medicare and medicaid services (CMS) waives or modifies the deadline, provider
			 agreement revalidation may be delayed as authorized by the CMS waiver or
			 modification. 
			 Provider agreements must also be revalidated whenever there is a change in risk
			 pursuant to
			 42 C.F.R.
			 455.450 (as in effect May
			 October 1,
			 2020) The revalidation process is as follows:
(1) The Ohio department of medicaid (ODM)
			 shall send a revalidation notice by  ninety days prior to the expiration date of the provider's
			 timelimited agreement either to the provider's
			 email or mailing address on file notifying the
			 provider that it is required to revalidate its agreement.
(2) The revalidation notice shall instruct
			 the provider what is required to complete the revalidation process. Providers
			 are expected to meet all conditions for participation as an eligible provider
			 that are in effect in Chapter 5160-1 of the Administrative Code at the time of
			 revalidation.
(3) The provider
			 shall submit all required information before the revalidation deadline date
			 specified in the revalidation notice including the required fee as specified in
			 rule 5160-1-17.8 of the Administrative Code.
(4) A provider shall not initiate
			 revalidation prior to the receipt of the revalidation notification sent by ODM.
			 This rule does not negate the requirement that a provider must properly
			 disclose any changes to its provider agreement in accordance with rule
			 5160-1-17.3 of the Administrative Code. The reporting of changes does not
			 constitute the initiation of revalidation and remains the provider's
			 responsibility.
(5) When a provider
			 fails to revalidate in the time and the manner required by ODM, as specified in
			 this rule and in accordance with the revalidation notice referred to in
			 paragraph (A)(1) of this rule, ODM shall deny an application for revalidation
			 and terminate the time-limited provider agreement. The denial and termination
			 will take effect thirty days after ODM mails a written notice to the provider
			 by regular mail to the address on file notifying the provider of the decision.
			 ODM shall specify in the notice the date on which the provider is required to
			 cease operating under a terminated provider agreement.
(6) If a provider files an application for
			 revalidation within the time and in the manner required, as specified in this
			 rule, but the provider agreement expires before ODM acts on the application or
			 before the effective date of the ODM decision on the application, the provider
			 may continue operating under the terms of the expired agreement until the
			 effective date of the ODM decision.
(7) If a provider files an application for
			 revalidation within the time and in the manner required, as specified in this
			 rule, but has not been able to obtain a renewal of its licensure,
			 certification, accreditation, or registration the application may be accepted
			 and processed by ODM as long as the granting official, board, commission,
			 department, division, bureau, or other agency of state or federal government
			 considers the provider in good standing and that its licensure, certification,
			 accreditation, or registration is still active.