RO Termination Processing Sequence - Noncompliance With

3024 - RO Termination Processing Sequence - Noncompliance With CoPs or Conditions for Coverage (Excluding SNFs) (Rev. 92, Issued, 11-22-13, Effective: 11-22-13, Implementation: 11-22-13) Upon receipt of the SA’s unfavorable certification, the RO: A. Establishes controls for processing the termination; B. Performs an initial documentary review to make certain that copies of all pertinent surveys, statements of deficiencies, plans of correction (if submitted by the provider), and other necessary documents are included and that all relevant issues are resolved. When unable to determine the relationship of cited deficiencies to the quality of services or the health and safety of patients, the RO requests further SA development. If necessary, the RO retains the file and phones the SA for the additional documentation needed; C. Does a substantive review, resolves all substantive discrepancies and disputes, assesses the severity of the provider’s/supplier’s noncompliance, and makes its determination. The RO consults with LSC specialists in the RO, if necessary. See discussion in §3026 concerning how to treat key documents in making your determination; D. Prepares the Termination Notice (Exhibits 181 and 182) and Newspaper Notice (Exhibit 183) and any supplemental press releases, if planned. The RO forwards a copy of its notice to the SMA, if appropriate; and E. Inserts the effective date of termination in the notice and makes the necessary arrangements for public notice. To give both the provider and the public sufficient advance notice of termination of a provider’s agreement (at least 2 calendar days if there is immediate jeopardy or at least 15 calendar days if there is no immediate jeopardy), the RO determines the effective date of termination as follows: • Allows sufficient time for delivery of the notice to the provider, depending on the provider’s location and the method of notification, i.e., letter, overnight mail, or electronic means. • Determines the time needed for actual public notice by contacting the local newspaper or radio and television stations to determine their deadlines. (See §3034); • Allows for receipt of the notice by the provider prior to publication of the public notice and assures that the public receives at least 2 calendar days if immediate jeopardy exists, otherwise 15 calendar days notice prior to the date of termination; • Mails the termination notice to the provider (return receipt requested); and • Notifies the SMA of action taken against Medicaid ICFs/IID and the effective dates if termination action is taken pursuant to §3000.C.3. When the termination action is taken, the RO mails the informational copies to the following offices: o Division of Medicare; o Division of Medicaid; o CO; o Intermediary; o SA; o SMA; o Regional Director, Department of Health and Human Services (DHHS); and o State Ombudsman.