An exiting operator or owner of an ICF/IID participating in the medicaid program shall provide the department of developmental disabilities and department of medicaid written notice of a facility closure or voluntary termination not less than ninety days before the effective date of the facility closure or voluntary termination. The written notice shall be provided to the department of developmental disabilities and department of medicaid in accordance with the method specified in rules authorized by section 5124.53 of the Revised Code.
The written notice shall include all of the following:
(A) The name of the exiting operator and, if any, the exiting operator's authorized agent;
(B) The name of the ICF/IID that is the subject of the written notice;
(C) The exiting operator's medicaid provider agreement number for the ICF/IID that is the subject of the written notice;
(D) The effective date of the facility closure or voluntary termination;
(E) The signature of the exiting operator's or owner's representative.