Library: Policy

317:30-5-124. Facility licensure

Revised 9-1-17

(a) Nursing home license required.A NF must meet state nursing home licensing standards to provide, on a regular basis, health related care and services to individuals who do not require hospital care.

(1) In order for long term care facilities to receive payment from the OHCA for the provision of nursing care, they must be currently licensed under provisions of Title 63 O.S., Nursing Home Care Act, Section 1-1900.1, et seq.

(2) The State Department of Health is responsible for the issuance, renewal, suspension, and revocation of a facility's license in addition to the enforcement of the standards. The denial, suspension, or revocation of a facility's license is subject to appeal to the State Department of Health. All questions regarding a facility's license should be directed to the State Department of Health.

(b) Certification survey.The State Department of Health is designated as the State Survey Agency and is responsible for determining a long term care facility's compliance with Title XIX requirements. The results of the survey are forwarded to the OHCA by the State Survey Agency.

(c) Certification period.The certification period of a long term care facility is determined by the State Survey Agency. In the event the facility's deficiencies are found to be of such serious nature as to jeopardize the health and safety of the member, the State Survey Agency may terminate (de-certify) the facility's certification period and notify the OHCA. Upon notification by the State Survey Agency, the OHCA will notify the facility by certified letter that the contract is being terminated. The letter will indicate the effective date and specify the time period that payment may continue in order to allow orderly relocation of the members. The decision to terminate a facility's certification by the State Survey Agency is subject to appeal to the State Department of Health.

(d) Certification with deficiencies.Certification of any facility that has been found to have deficiencies by the State Survey Agency will be governed by 42 CFR 442.110 (certification period for ICF/IID with standard-level deficiencies) or 42 CFR 442.117 (termination of certification for ICFs/IID whose deficiencies pose immediate jeopardy).

(e) Contract procedures.

(1) A facility participating in the Medicaid program will be notified by the OHCA 75 days prior to the expiration of the existing contract. The facility must complete a new contract to continue participation in the SoonerCare program.

(2) When the contract is received, approved by the OHCA, and the HCFA-1539 has been received from the State Department of Health indicating the facility's certification period, the contract will be completed.

(3) Intermediate care facilities for individuals with intellectual disabilities(ICF/IID) wishing to participate in the ICF/IID program must be approved and certified by the State Survey Agency as being in compliance with the ICF/IID regulations (42 CFR 442 Subpart C). It is the responsibility of a facility to request the State Survey Agency perform a survey of compliance with ICF/IID regulations.

(A) When the OHCA has received notification of a facility's approval as an ICF/IID and the Title XIX survey of compliance has begun, the contract will be sent to the facility for completion.

(B) A facility which has been certified as an ICF/IID and has a contract with the OHCA will be paid only for members that have been approved for ICF/IID level of care. When the facility is originally certified to provide ICF/IID services, payment for member's currently residing in the facility who are approved for a NF level of care will be made if such care is appropriate to the member's needs.

(f) New facilities.Any new facility in Oklahoma must receive a Certificate of Need from the State Department of Health. It is the responsibility of the new facility to request the State Survey Agency to perform a survey for Title XIX compliance.

(1) When construction of a new facility is completed and licensure and certification is imminent, facilities wishing to participate in the Title XIX Medicaid Program may apply electronically to become a Medicaid contracted provider.

(2) In no case can payment be made for any period prior to the effective date of the facility's certification.

(g) Change of ownership.The acquisition of a facility operation, either whole or in part, by lease or purchase, or if a new Federal Employer Identification Number is required, constitutes a change of ownership. The new owner must follow provisions of the Nursing Home Care Act at Title 63 O.S. Section 1-1905 (D) (relating to transfers in ownership) and OAC 310:675-3-8 (relating to notice of change), as applicable. When such change occurs, it is necessary that a new contract be completed between the new owner and the OHCA in order that payment can continue for the provision of nursing care.

(1) License changes due to change of ownership.State Law prescribes specific requirements regarding the transfer of ownership of a NF from one person to another. When a transfer of ownership is contemplated, the buyer/seller or lessee/lessor must notify the State Department of Health prior to the final transfer and apply for a new facility license.

(2) Certificate of Need. A change of ownership is subject to review by the State Department of Health. Any person contemplating the acquisition of a NF should contact the State Department of Health for further information regarding Certificate of Need requirements.

(A) The new owner must obtain a Certificate of Need as well as a new facility license from the State Department of Health. Pending notification of licensure, no changes will be made to the OHCA's facility records with the exception of change in administrator or change in name, if applicable.

(B) When a change in ownership does occur, the OHCA will automatically assign the contract to the new owner per federal regulation. By signing the contract, the new owner is representing to the OHCA that they meet the requirements of the contract and the requirements for participation in the Medicaid program. The new owner's contract is subject to the prior owner's contract terms and conditions that were in effect at the time of transfer of ownership, including compliance with all appropriate federal regulations.

(h) A nursing facility or ICF/IID dissatisfied with an action taken by the OHCA that is appealable as a matter of right pursuant to Subpart D of Part 431 of Title 42 of the Code of Federal Regulations, shall be afforded a hearing as provided by 42 CFR 431.153 or 431.154.