Library: Policy

317:2-1-8. Nursing home provider contract appeals

Revised 7-21-09

     This Section explains the appeal process to be accorded all nursing home providers whose contracts are terminated, denied or non-renewed.  No procedure is afforded a nursing facility whose contract is limited in any other fashion.

• (1) If a nursing home provider's contract is terminated, non-renewed or denied prior to the action's effective date, the provider will be afforded an informal reconsideration in accordance with 42 C.F.R. 421.153.

• (2) The notice of termination, non-renewal or, denial of contract will include the findings it was based upon.  The letter will be sent by certified mail to the provider.

• (3) The provider will have 60 days to respond to the notice unless there is a finding of immediate jeopardy or a determination that the facility's SoonerCare certification has been cancelled prior to 60 days.  The response should outline the reasons why the OHCA's decision to terminate, non-renew, or deny the contract is wrong.  The response by the provider must include a detailed position addressing the findings set out in the OHCA's letter.  In the event that less than a 60 day notice is provided for either reason stated above, the provider will be afforded a notice in as much time before decertification as possible.

• (4) Based upon the provider's response, the OHCA will affirm or deny the notice of non-renewal, termination or denial.