Ohio Code 5164.32 – Expiration of medicaid provider agreements
(A) Each medicaid provider agreement shall expire not later than five years from its effective date. If a provider agreement entered into before the effective date of this amendment does not have a time limit, the department of medicaid shall convert the agreement to a provider agreement with a time limit.
Terms Used In Ohio Code 5164.32
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- medicaid provider: includes a person or government entity applying for a provider agreement, a former medicaid provider, or both. See Ohio Code 5164.01
- Provider agreement: means an agreement to which all of the following apply:
(1) It is between a medicaid provider and the department of medicaid;
(2) It provides for the medicaid provider to provide medicaid services to medicaid recipients;
(3) It complies with 42 C. See Ohio Code 5164.01
(B) The medicaid director shall adopt rules under section 5164.02 of the Revised Code as necessary to implement this section. The rules shall be consistent with subpart E of 42 C.F.R. Part 455 and include a process for revalidating medicaid providers’ continued enrollments as providers. All of the following apply to the revalidation process:
(1) The department shall refuse to revalidate a provider’s provider agreement when the provider fails to file a complete application for revalidation within the time and in the manner required under the revalidation process.
(2) If a provider files a complete application for revalidation within the time and in the manner required under the revalidation process, but the provider agreement expires before the department acts on the application or before the effective date of the department’s decision on the application, the provider, subject to division (B)(3) of this section, may continue operating under the terms of the expired provider agreement until the effective date of the department’s decision.
(3) If a provider continues operating under the terms of an expired provider agreement pursuant to division (B)(2) of this section and the department denies the provider’s application for revalidation, medicaid payments shall not be made for services or items the provider provides during the period beginning on the date the provider agreement expired and ending on the effective date of a subsequent provider agreement, if any, the department enters into with the provider.