(A) An exiting operator or owner and entering operator shall provide the department of developmental disabilities and department of medicaid written notice of a change of operator if the ICF/IID participates in the medicaid program and the entering operator seeks to continue the ICF/IID's participation. 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 be provided to the department of developmental disabilities and department of medicaid not later than forty-five days before the effective date of the change of operator if the change of operator does not entail the relocation of residents. The written notice shall be provided to the department of developmental disabilities and department of medicaid not later than ninety days before the effective date of the change of operator if the change of operator entails the relocation of residents. The written notice shall include all of the following:

1. (1) The name of the exiting operator and, if any, the exiting operator's authorized agent;
2. (2) The name of the ICF/IID that is the subject of the change of operator;
3. (3) The exiting operator's seven-digit medicaid legacy number and ten-digit national provider identifier number for the ICF/IID that is the subject of the change of operator;
4. (4) The name of the entering operator;
5. (5) The effective date of the change of operator;
6. (6) The manner in which the entering operator becomes the ICF/IID's operator, including through sale, lease, merger, or other action;
7. (7) If the manner in which the entering operator becomes the ICF/IID's operator involves more than one step, a description of each step;
8. (8) Written authorization from the exiting operator or owner and entering operator for the department of medicaid to process a provider agreement for the entering operator;
9. (9) The names and addresses of the persons to whom the department of developmental disabilities and department of medicaid should send initial correspondence regarding the change of operator;
10. (10) The signature of the exiting operator's or owner's representative.