(A) This rule prescribes the procedure
under which a nursing facility submits a plan of correction for findings and
deficiencies cited as the result of a survey by the department of health. The
rule also prescribes the procedure for a facility to obtain informal review of
deficiencies that were included on a statement of deficiencies prepared by the
department under 42 C.F.R. Part 488 (2011). As used in this rule:
(1) "Nursing
facility" means a facility, or a distinct part of a facility, that is
certified as a nursing facility by the director of health in accordance with
Title XIX of the Social Security Act, 49 Stat. 620, 42 U.S.C. 301, as amended
(1981), and is not an intermediate care facility for individuals with
intellectual disabilities. "Nursing facility" includes a facility, or
distinct part of a facility, that is certified as a nursing facility by the
director of health in accordance with Title XIX of the Social Security Act, and
is certified as a skilled nursing facility by the director in accordance with
Title XVIII of the Social Security Act.
(2) "Deficiency" means a finding cited by the
department during a survey conducted under 42 C.F.R. Part 488 (2011), on the
basis of one or more actions, practices, situations, or incidents occurring at
a nursing facility.
(3) "Survey"
means a survey of a nursing facility conducted under section 5165.64 of the
Revised Code and under 42 C.F.R. Part 488 (2011).
(4) "Follow-up
survey" means a survey conducted by the department to determine whether a
nursing facility has substantially corrected deficiencies cited in a previous
survey.
(5) "Statement of
deficiencies" means the detailed statement prepared by the department
under 42 C.F.R. Part 488 (2011) that sets forth all findings and deficiencies
cited on the basis of a survey.
(6) "Department" means the department of
health.
(B) When delivering a statement of
deficiencies to a nursing facility, the department will do so in such a manner
that the statement is received by the facility no later than one business day
after it is sent.
(C) Whenever a nursing facility receives
a statement of deficiencies, the facility will submit to the department for its
approval, no later than ten days after receipt of the statement, a plan of
correction for each finding or deficiency cited in the statement. The plan will
describe the actions the facility will take to correct each finding or
deficiency and specify the date by which each finding or deficiency will be
corrected. In the case of a finding or deficiency that was substantially
corrected before the survey, the plan will describe the actions the facility
took to correct the finding or deficiency and the date on which it was
corrected.
(D) The department will notify the facility of the right to
request informal review of any deficiency cited on the statement of
deficiencies. A facility will not be afforded an opportunity for an independent
informal dispute resolution under 42 C.F.R. 488.331 (2011) for the same
deficiency unless the first informal review conducted under paragraph (E) of
this rule was completed prior to the imposition of a civil money penalty. In
the case of a follow-up survey, the facility may request informal review only
of deficiencies that were cited on the follow-up survey but not on the original
survey. The facility is not allowed to request informal review of deficiencies
cited on the original survey that were cited as not corrected on the follow-up
survey.
(1) The department will
notify the facility of the right to request informal review at the same time
that the department provides the facility with the statement of
deficiencies.
(2) The facility will
request informal review, in a manner prescribed by the director, within the
time for submitting the plan of correction, as prescribed by paragraph (C) of
this rule. The request for informal review will include all of the following
items:
(a) Identification of the specific deficiencies for which the
facility is requesting review;
(b) A written statement explaining why the facility believes that
the deficiency should not have been cited or a different severity or scope
level for deficiencies constituting immediate jeopardy or substandard quality
of care, as defined under 42 C.F.R. Part 488 (2011), should have been assigned.
The statement may be accompanied by any other documentation that the facility
chooses to submit; and
(c) The name of an individual at the facility whom the department
may contact concerning the request, his or her telephone number, and the times
between 7:45 a.m. and 4:30 p.m. when the individual can be reached each
day.
(E) If informal review is requested in a timely manner, the
review will be conducted in accordance with the following
procedures:
(1) The first informal
review will be conducted by an employee of the department who did not
participate in and was not directly involved in performing the survey. Within
ten working days after the department receives the request, the department will
telephone the facility's designated contact or, if the contact is
unavailable, the administrator or other person in charge of the facility. In
the telephone conversation, the department will summarize the results of the
review.
(2) If the facility is
satisfied with the results of the first informal review, the informal review
process will conclude. If the informal review results in a determination that
one or more deficiencies should not have been cited or should have been cited
under a different requirement or that a different scope or severity level
should have been assigned, the department will issue a revised page or pages of
the statement of deficiencies reflecting that determination.
(3) A facility that is
not satisfied with the results of a first review may request, in a manner
prescribed by the director, a second informal review of deficiencies that cause
the facility to be in noncompliance as defined in 42 C.F.R. 488.301 (2003). The
facility will request this second review and pay the fee prescribed under
paragraph (F)(1) of this rule within ten days of being informed of the results
of the first review.
(a) If the facility requests a second informal review under this
paragraph, the second review will be conducted by either of the following as
selected by the facility:
(i) A hearing officer
employed by the department; or
(ii) A hearing officer
included on a list the department will provide the facility.
(b) Upon receipt of the fee required under paragraph (F)(1) of
this rule, the department will assign a hearing officer to the second review.
The hearing officer will notify the department of the results of the second
informal review no later than thirty days after the hearing officer has been
assigned the review.
(c) After review of the hearing officer's report, the
department will notify the facility's designated contact person by
telephone of the department's final determination.
(d) Upon receipt of the fee required under paragraph (F)(2) of
this rule, the department will update all records relating to the survey to
reflect a final determination that:
(i) Any deficiency should
not have been cited;
(ii) Any deficiency
should have been cited under a different requirement; or
(iii) A different severity or scope should have been assigned for
any deficiency constituting immediate jeopardy or substandard quality of
care.
(F) A facility that requests a second informal review, under
paragraph (E) of this rule, will pay the following fee in a manner prescribed
by the director and this paragraph:
(1) A non-refundable fee
of one hundred and fifty dollars which will be paid in accordance with
paragraph (E)(3) of this rule; and
(2) A fee of seventy-five
dollars per hour for each hour it takes the hearing officer to complete the
review which will be paid within thirty days after the facility receives the
department's invoice.
(G) The department's failure to meet any of the time frames
specified by this rule will not invalidate any finding or
deficiency.
