Or. Admin. Code § 411-048-0220

Current through Register Vol. 63, No. 11, November 1, 2024

Section 411-048-0220 - Medicaid Provider Disenrollment / Termination

(1) Enrolled Medicaid providers of long term care community nursing services, or RN employees of an agency enrolled as a Medicaid provider delivering long term care community nursing services may be denied enrollment, terminated, or prohibited from providing long term care community nursing services for, but not limited to, any of the following:

(a) Violation of any part of these rules at any time.

(b) Violation of the protective service and abuse rules in OAR chapter 411, division 020 and OAR chapter 407, division 045.

(c) Violation of the applicable service rules in OAR chapter 410, division 120 or 173, or the provider rules in OAR chapter 333, division 027 or 536.

(d) Any sanction or action as a result of an OSBN investigation.

(e) Failure to keep required licensure or certifications current.

(f) Failure to provide copies of the records described in these rules to designated Department or Oregon Health Authority entities.

(g) Failure to participate in Nursing Service Plan review or care coordination meetings when requested by an individual's case manager.

(h) Failure to obtain a pass score on the Department's test on OSBN's OAR division 006, 045, and 047 as requested by the Department.

(i) Failure to provide services.

(j) Fraud or misrepresentation in the application for enrollment or for the provision of long-term care community nursing services.

(k) Evidence of conduct derogatory to the standards of nursing as described in OAR 851-045-0070 that results in referral to OSBN.

(l) A demonstrated pattern of repeated unsubstantiated complaints of neglect or abuse per OAR chapter 411, division 020 or OAR chapter 407, division 045.

(m) Exclusion by the Office of Inspector General from participating in publicly funded programs. Agencies listed in section (3)(b) and (c) of this rule are prohibited from employing or paying any excluded person or entity and must promptly notify the Authority Health Systems Division's Provider Enrollment Unit or the Office of Inspector General in writing of any violation.

(2) Enrolled Medicaid providers may appeal a termination of their Medicaid provider number based on OAR 407-120-0360(8)(g) and OAR chapter 410, division 120 as applicable.

(3) Enrolled Medicaid providers of long term care community nursing services must provide advance written notice to the Department at least 30 days prior to no longer providing long term care community nursing services.

(4) An RN ending long term care community nursing services must comply with the OSBN's standards regarding transition of care and transfer or rescinding of delegations per OAR chapter 851, division 047.

Or. Admin. Code § 411-048-0220

SPD 8-2013, f. & cert. ef. 4-15-13; APD 30-2021, amend filed 08/25/2021, effective 8/25/2021; APD 18-2023, amend filed 10/13/2023, effective 11/1/2023

Statutory/Other Authority: ORS 409.050 & 410.070

Statutes/Other Implemented: ORS 409.010 & 410.070