Or. Admin. R. 411-323-0030 - Certification
(1) CERTIFICATION.
A person, agency, or governmental unit acting individually or jointly with any
other person, agency, or governmental unit intending to operate a program as
defined in OAR 411-323-0020 must be certified by the Department under these
rules before establishing, conducting, maintaining, managing, or operating an
agency.
(a) Certificates are not
transferable.
(b) The Department
issues or renews a certificate to an agency found to be in compliance with
these rules, the rules in OAR chapter 411, division 004, and the corresponding
program rules. The certificate is effective for two years from the date issued
unless sooner revoked or suspended.
(c) If an agency fails to provide complete,
accurate, and truthful information during the application or renewal process,
the Department may delay initial certification, deny the application, or revoke
or refuse to renew the application for certification.
(d) For the purpose of certification, any
applicant or person with an ownership interest in an agency is considered
responsible for acts occurring during, and relating to, the operation of the
agency.
(e) The Department may
consider the background and operating history of the applicant and each person
with an ownership interest when determining whether to issue or renew a
certificate.
(f) A review of the
agency is conducted by the Department prior to the issuance or renewal of a
certificate.
(2) CURRENT
AGENCY CERTIFICATION.
(a) All agencies are
certified for two years unless the certificate is sooner revoked or
suspended.
(b) An agency licensed
or certified under OAR chapter 411, division 054 for residential care and
assisted living facilities, OAR chapter 309, division 035 for residential
treatment facilities and residential treatment homes for adults with mental
health disorders, OAR chapter 413, division 215 for child-caring agencies, or
OAR chapter 416, division 550 for youth offender treatment foster care, and as
may be described in corresponding program rules, does not require additional
certification as an agency under these rules to deliver services. Current
license or certification is considered sufficient demonstration of ability to:
(A) Recruit, hire, supervise, and train
qualified staff;
(B) Deliver
services according to an ISP or Service Agreement; and
(C) Develop and implement operating policies
and procedures required for managing an agency and delivering services,
including provisions for safeguarding individuals receiving services.
(3) INITIAL
CERTIFICATION. Notwithstanding section (2) of this rule, an applicant intending
to provide program services as defined in OAR 411-323-0020 must apply for an
initial certificate and demonstrate to the satisfaction of the Department that
the applicant is in compliance with these rules, the rules in OAR chapter 411,
division 004, and the corresponding program rules.
(a) The applicant must submit an application
to the Department at least 90 calendar days prior to the proposed date of
delivery of services to individuals. The completed application must be on the
applicable Department form and must include all information requested by the
Department.
(b) At a minimum, the
applicant must provide:
(A) A copy of any
management agreements or contracts relative to the operation and ownership of
the agency;
(B) A financial plan
that includes financial statements indicating capital and the financial plan
developed to assure sustainability, partnerships, loans, and any other
financial assistance; and
(C) As
required by
42
CFR 455.104, the name, date of birth, and
social security number for each person currently serving as the Board of
Directors for the agency, and as changes are made.
(c) The applicant must develop a plan
identifying the scope of services the applicant intends to provide and request
endorsement for each program type as described in OAR 411-323-0035.
(d) The applicant must demonstrate proof of
liability and operational insurance coverage.
(A) The agency must, at the expense of the
agency, maintain in effect with respect to all occurrences taking place during
the certification period, liability and operational insurance as described in
the contract the agency has with the Department including, but not limited to,
automobile liability insurance, comprehensive or commercial general liability
insurance, and workers' compensation coverage if required.
(B) The agency must name the State of Oregon,
Department of Human Services and the divisions, officers, and employees of the
Department as additionally insured on any insurance policies required by their
contract with respect to agency activities being performed under the
certification of the agency. Such insurance must be issued by an insurance
company licensed to do business in Oregon and must contain a 30-day notice of
cancellation endorsement.
(C) The
agency must forward certificates of insurance indicating coverage to the
Department as required by this rule.
(D) In the event of unilateral cancellation
or restriction by the insurance company of any insurance coverage required by
their contract, the agency must immediately notify the Department orally of the
cancellation or restriction and must confirm the cancellation or restriction in
writing within three calendar days of receiving notification from the insurance
company.
(4)
CERTIFICATE RENEWAL.
(a) To renew a
certificate, an agency must:
(A) Submit an
application to the Department at least 90 calendar days prior to the expiration
date of the existing certificate for the agency. The completed application must
be on the applicable Department form and must include all information requested
by the Department. At a minimum, the agency must provide the following:
(i) A copy of any management agreements or
contracts relative to the operation and ownership of the agency.
(ii) A financial plan that includes audits
for the previous two years as described in section (5) of this rule.
(iii) As required by
42
CFR 455.104, the name, date of birth, and
social security number for each person currently serving as the Board of
Directors for the agency, and as changes are made.
(B) Identify the scope of services the agency
provides and provide proof of endorsement for each program service as described
in OAR 411-323-0035.
(C)
Demonstrate to the satisfaction of the Department that the agency is in
compliance with these rules, the rules in OAR chapter 411, division 004, and
the corresponding program rules.
(D) Demonstrate proof of continued liability
and operational insurance coverage as described in section (3)(d) of this
rule.
(b) An application
for renewal filed with the Department before the date of expiration extends the
effective date of the existing certificate until the Department takes action
upon the application for renewal.
(c) If the renewal application is not
submitted to the Department prior to the date the certificate expires, the
agency is considered a non-certified Medicaid agency and is subject to
termination of their Medicaid Agency Identification Number.
(5) FINANCIAL AUDITS.
(a) An agency certified and endorsed to
provide program services, receiving revenue of $1,000,000 or more per fiscal
year, must obtain an audit at least once during the biennium.
(b) An agency certified and endorsed to
provide program services, receiving less than $1,000,000 in revenue per fiscal
year, must submit financial statements that have been audited, reviewed, or
compiled by a Certified Public Accountant at least once during the
biennium.
(c) An audit or the
audited financial statements must be submitted to the Department within 90
calendar days of the end of the fiscal year following.
(6) CERTIFICATE EXPIRATION. Unless revoked,
suspended, or terminated earlier, a certificate to operate as a Medicaid
provider agency expires two years following the date of issuance.
(7) CERTIFICATE TERMINATION. A certificate
automatically terminates on the date agency operation is discontinued or if
there is a change in ownership.
(8)
RETURN OF CERTIFICATE. A certificate must be returned to the Department
immediately upon suspension or revocation of the certificate or when agency
operation is discontinued.
(9)
CHANGE OF OWNERSHIP, LEGAL ENTITY, LEGAL STATUS, OR MANAGEMENT CORPORATION.
(a) An agency must notify the Department in
writing of any pending change in the ownership, legal entity, legal status, or
management corporation of the agency.
(b) A new certificate is required upon a
change in the ownership, legal entity, legal status, or management corporation
of the agency. An agency must submit an application as described in section (3)
of this rule to the Department at least 30 calendar days prior to a change in
ownership, legal entity, legal status, or management corporation.
(10) CERTIFICATE ADMINISTRATIVE
SANCTION. An administrative sanction may be imposed for non-compliance with
these rules, the rules in OAR chapter 411 division 004, or the corresponding
program rules. An administrative sanction on a certificate includes one or more
of the following actions:
(a) A condition as
described in section (11) of this rule.
(b) Denial, revocation, or refusal to renew a
certificate as described in section (12) of this rule.
(c) Immediate suspension of a certificate as
described in section (13) of this rule.
(11) CERTIFICATE CONDITIONS.
(a) The Department may attach conditions to a
certificate that limit, restrict, or specify other criteria for operation of an
agency. The type of condition attached to a certificate must directly relate to
a risk of harm or potential risk of harm to individuals.
(b) The Department may attach a condition to
a certificate upon any of the following findings:
(A) Information on the application or initial
inspection requires a condition to protect the health, safety, or welfare of
individuals.
(B) A threat to the
health, safety, or welfare of an individual exists.
(C) There is evidence of abuse, neglect, or
exploitation.
(D) The agency is not
being operated in compliance with these rules, the rules in OAR chapter 411,
division 004, or the corresponding program rules.
(c) Conditions that the Department may impose
on a certificate include, but are not limited to, the following:
(A) Restricting the total number of
individuals to whom an agency may deliver services.
(B) Restricting the total number of
individuals to whom an agency may deliver services based upon the capability
and capacity of the agency and staff to meet the health and safety needs of all
individuals.
(C) Restricting the
type of support and services an agency may deliver to individuals based upon
the capability and capacity of the agency and staff to meet the health and
safety needs of all individuals.
(D) Requiring additional staff or staff
qualifications.
(E) Requiring
additional training.
(F)
Restricting an agency from allowing a person on the premises who may be a
threat to the health, safety, or welfare of an individual.
(G) Requiring additional
documentation.
(H) Restricting
enrollments.
(d) NOTICE
OF CERTIFICATE CONDITIONS. The Department issues a written notice to the agency
when the Department imposes conditions on the certificate of the agency. The
written notice of certificate conditions includes the conditions imposed by the
Department, the reason for the conditions, and the opportunity to request a
hearing under ORS chapter 183.
(A) Conditions
take effect immediately upon issuance of the written notice of certificate
conditions or at a later date as indicated on the notice and are a Final Order
of the Department unless later rescinded through the hearing process.
(B) The conditions imposed remain in effect
until the Department has sufficient cause to believe the situation that
warranted the condition has been remedied.
(e) HEARING.
(A) An agency may request a hearing in
accordance with ORS chapter 183 and this rule upon receipt of written notice of
certificate conditions. The request for a hearing must be in writing. An agency
must request a hearing within 21 calendar days from the receipt of the written
notice of certificate conditions.
(B) In addition to, or in-lieu of a hearing,
an agency may request an administrative review as described in section (14) of
this rule. The request for an administrative review must be in writing. The
administrative review does not diminish the right of the agency to a
hearing.
(C) The Department shall
be allowed reasonable requests for setting or postponement of any hearing to
allow for the conclusion of a protective services investigation when a
condition is imposed related to the protective services
investigation.
(f) An
agency may send a written request to the Department to remove a condition if
the agency believes the situation that warranted the condition has been
remedied.
(g) Conditions must be
posted with the certificate in a prominent location and be available for
inspection at all times.
(12) CERTIFICATE DENIAL, REFUSAL TO RENEW, OR
REVOCATION.
(a) The Department may deny,
refuse to renew, or revoke a certificate when the Department finds an agency or
any person holding 5 percent or greater ownership interest in the agency:
(A) Demonstrates substantial failure to
comply with these rules, the rules in OAR chapter 411, division 004, or the
corresponding program rules such that the health, safety, or welfare of
individuals is jeopardized and the agency fails to correct the non-compliance
within 30 calendar days from the receipt of written notice of
non-compliance;
(B) Has
demonstrated a substantial failure to comply with these rules, the rules in OAR
chapter 411, division 004, or the corresponding program rules such that the
health, safety, or welfare of individuals is jeopardized;
(C) Has been convicted of any crime that
would have resulted in an unacceptable background check upon hiring or
authorization of program services;
(D) Has been convicted of a misdemeanor
associated with the operation of an agency or program services;
(E) Falsifies information required by the
Department to be maintained or submitted regarding program services, agency
finances, or funds belonging to the individuals;
(F) Has been found to have permitted, aided,
or abetted any illegal act that has had significant adverse impact on
individual health, safety, or welfare; or
(G) Has been placed on the current Centers
for Medicare and Medicaid Services list of excluded or debarred providers
maintained by the Office of the Inspector General.
(b) NOTICE OF CERTIFICATE DENIAL, REVOCATION,
OR REFUSAL TO RENEW. The Department may issue a notice of denial, refusal to
renew, or revocation of a certificate following a Department finding that there
is a substantial failure to comply with these rules, the rules in OAR chapter
411, division 004, or the corresponding program rules such that the health,
safety, or welfare of individuals is jeopardized, or that one or more of the
events listed in subsection (a) of this section has occurred.
(c) HEARING. An applicant for a certificate
or a certified agency, as applicable, may request a hearing in accordance with
ORS chapter 183, this rule, and ORS
443.440
for a 24-hour residential or host home program, upon written notice from the
Department of denial, refusal to renew, or revocation of a certificate. The
request for a hearing must be in writing.
(A)
DENIAL. The applicant must request a hearing within 60 calendar days from the
receipt of the written notice of denial.
(B) REFUSAL TO RENEW. The agency must request
a hearing within 60 calendar days from the receipt of the written notice of
refusal to renew.
(C) REVOCATION.
(i) Notwithstanding subsection (ii) of this
section, the agency must request a hearing within 21 calendar days from the
receipt of the written notice of revocation.
(I) In addition to, or in-lieu of a hearing,
the agency may request an administrative review as described in section (14) of
this rule. The request for an administrative review must be in
writing.
(II) The administrative
review does not diminish the right of the agency to a hearing.
(ii) An agency endorsed to operate
a 24-hour residential program as described in OAR chapter 411, division 325 or
a host home program as described in OAR chapter 411, division 348, must request
a hearing within 10 calendar days from the receipt of the written notice of
revocation.
(13) IMMEDIATE SUSPENSION OF CERTIFICATE.
(a) When the Department finds a serious and
immediate threat to individual health and safety and sets forth the specific
reasons for such findings, the Department may, by written notice to an agency,
immediately suspend a certificate without a pre-suspension hearing and the
agency may not continue operating.
(b) HEARING. The agency may request a hearing
in accordance with ORS chapter 183, this rule, and ORS
443.440
for a 24-hour residential or host home program, upon written notice from the
Department of the immediate suspension of the certificate. The request for a
hearing must be in writing.
(A)
Notwithstanding subsection (B) of this section, the agency must request a
hearing within 21 calendar days from the receipt of the written notice of
suspension.
(i) In addition to, or in-lieu of
a hearing, the agency may request an administrative review as described in
section (14) of this rule. The request for an administrative review must be in
writing.
(ii) The administrative
review does not diminish the right of the agency to a hearing.
(B) An agency endorsed to operate
a 24-hour residential program as described in OAR chapter 411, division 325 or
a host home program as described in OAR chapter 411, division 348, must request
a hearing within 10 calendar days from the receipt of the written notice of
suspension.
(14) ADMINISTRATIVE REVIEW.
(a) Notwithstanding subsection (b) of this
section, an agency, in addition to the right to a hearing, may request an
administrative review. The request for an administrative review must be in
writing.
(b) An agency endorsed to
operate a 24-hour residential program as described in OAR chapter 411, division
325 or a host home program as described in OAR chapter 411, division 348, may
not request an administrative review for revocation or suspension. An agency
endorsed to operate a 24-hour residential program as described in OAR chapter
411, division 325 or a host home program as described in OAR chapter 411,
division 348 may request an administrative review for imposition of
conditions.
(c) The Department must
receive a written request for an administrative review within 10 business days
from the receipt of the notice of suspension, revocation, or imposition of
conditions. An agency may submit, along with the written request for an
administrative review, any additional written materials the agency wishes to
have considered during the administrative review.
(d) The determination of the administrative
review is issued in writing within 10 business days from the receipt of the
written request for an administrative review, or by a later date as agreed to
by the agency.
(e) An agency,
notwithstanding subsection (b) of this section, may request a hearing if the
decision of the Department is to affirm the suspension, revocation, or
condition. The request for a hearing must be in writing. The Department must
receive the written request for a hearing within 21 calendar days from the
receipt of the original written notice of suspension, revocation, or imposition
of conditions.
(15)
INFORMAL CONFERENCE. Unless an administrative review has been completed as
described in section (14) of this rule, an applicant or agency requesting a
hearing may have an informal conference with the Department.
Notes
Statutory/Other Authority: ORS 409.050
Statutes/Other Implemented: ORS 427.007 & 430.215
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