Or. Admin. Code § 409-055-0070

Current through Register Vol. 63, No. 12, December 1, 2024

Section 409-055-0070 - Compliance

(1) If the Authority finds that the practice is not in compliance with processes as attested to, the Authority shall issue a written warning requiring the practice to submit an improvement plan within 90 days of the date of the written warning. The improvement plan must include a description of the practice's plan and timeline to correct the deficiency and proposed documentation or other demonstration that would verify the practice is in compliance.

(2) The Authority shall review the improvement plan and any documentation the practice submits in accordance with the deficiency, and if remedied, no further action shall be taken.

(3) If a practice fails to submit the improvement plan or move into compliance within 90 days of the date of the written warning, the Authority may issue a letter of non-compliance and amend the practice's PCPCH recognition to reflect the appropriate Tier level or revoke its PCPCH status.

(4) If the Authority amends a practice's tier level or revokes PCPCH status this information shall be made available to the Health Systems Division (Division), the coordinated care or managed care plans, and insurance carriers.

(5) A practice that has had its PCPCH status revoked may have it reissued after reapplying for recognition and when the Authority determines that compliance with PCPCH Standards has been achieved satisfactorily.

(6) The Authority may revoke a practice's PCPCH recognition in the following circumstances:

(a) The practice submits false quantitative data elements or falsely attests to meeting PCPCH recognition criteria;

(b) The practice misrepresents its PCPCH status or tier level;

(c) The practice is not compliant with a verification review as described in OAR 409-055-0060.

Or. Admin. Code § 409-055-0070

OHP 6-2011(Temp), f. 9-29-11, cert. ef. 10-1-11 thru 3-15-12; OHP 2-2012, f. 2-29-12, cert. ef. 3-1-12; OHP 9-2013, f. 10-1-13, cert. ef. 1-1-14; OHP 10-2015(Temp), f. 12-29-15, cert. ef. 1-1-16 thru 6-24-16; OHP 9-2016, f. & cert. ef. 5/13/2016; OHP 15-2018, amend filed 11/29/2018, effective 12/01/2018; OHP 18-2018, minor correction filed 12/03/2018, effective 12/3/2018; OHP 3-2020, amend filed 08/10/2020, effective 8/10/2020

Statutory/Other Authority: ORS 413.042, ORS 413.259 & 414.655

Statutes/Other Implemented: ORS 413.259, 413.260 & 414.655