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Agency Schedule Detail

Authorization Number :  50750121
Agency Series No. :  405-86-55
Status :  Active
Agency Web Link : 
Agency :  ODM
Confidential Description :   May contain patient personal and health related information.
Division :  ODMPOLI
Vital Description : 
Section :  ODMPOLILTSS
Record Title :  Long Term Care Provider Agreement Files
Revision :  1
Record Description :  Long Term Care facility provider agreements for Medicaid Facilities. Files contain documentation used to support payment/non-payment of services and nursing facilities (NF). Files contain documentation used to support payment/non-payment of services, reflecting changes in facility operations and showing how the agency fulfills its contracts with the federal government to administer the Medicaid program. Includes licenses, cost reports, rate settling reconsiderations and adjustments, adjudication master file, compliance audit findings, pending litigation, complaints about the facility or its patients, facility certification sheets, certification survey packets, operator bankruptcies, exit conferences and facility evaluations, and related correspondence through 2015.
Retention Period Retention Justification Media Code Method of Disposal
Retain in office until agreement is canceled, and then send all documents except provider agreement to State Records Center for 7 years. Then destroy provided all agency, state and federal requirements have been met. OAC 5101:3-3-19 5111.28 ORC 2913.40(D) 5101:3-3-26 Paper Shred

Approvals

Status Name Title Date
Approved Dennis Hawk Records Coordinator 1/24/2020 2:04:00 PM
Approved Katherine DuMond Records Officer 12/19/2023 5:38:32 PM
Approved Terri Dittmar Record Administrator 12/20/2023 7:06:37 AM
Approved Martin Meeks State Auditor 12/21/2023 1:01:14 PM
Approved Fred Previts State Archivist 12/28/2023 2:14:11 PM

Notes

Date Reason User

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