PROVIDER ENROLLMENT AGREEMENT.
applicant or licensee who intends to provide care and services to support
individuals who are or become eligible for Medicaid services must enter into a
Medicaid Provider Enrollment Agreement with the Department, follow Department
rules, and abide by the terms of the Agreement. A Medicaid Provider Enrollment
Agreement is not approved unless the Department has determined that the
applicant, licensee, co-licensee, or any owner or officer of the corporation,
as applicable, is not listed on the Exclusion Lists for the Office of Inspector
General or the U.S. General Services Administration (System for Award
(b) An approved
Medicaid Provider Enrollment Agreement does not guarantee the placement of
individuals eligible for Medicaid services in an AFH-DD.
(c) An approved Medicaid Provider Enrollment
Agreement is valid for the length of the license unless earlier terminated by
the licensee or the Department. A Medicaid Provider Enrollment Agreement must
be completed, submitted, approved, and renewed with each licensing cycle.
(d) An individual eligible for
Medicaid services may not be admitted into an AFH-DD unless and until the
Department has approved a Medicaid Provider Enrollment Agreement. Medicaid
payment is not issued to a licensee without a current license and an approved
Medicaid Provider Enrollment Agreement in place.
(e) The rate of compensation established by
the Department is considered payment in full. The licensee may not request or
accept additional funds or in-kind payment from any source.
(f) The Department does not issue payment for
the date of the exit of an individual or for any time period thereafter.
(g) The licensee or the Department
may terminate a Medicaid Provider Enrollment Agreement according to the terms
of the Agreement.
Department may terminate a Medicaid Provider Enrollment Agreement under the
(A) The licensee
fails to maintain substantial compliance with all related federal, state, and
local laws, ordinances, and regulations; or
(B) The license to operate the AFH-DD has
been voluntarily surrendered, revoked, or not renewed.
The Department must terminate a Medicaid
Provider Enrollment Agreement under the following circumstances:
(A) The licensee fails to permit access by
the Department or CMS to any AFH-DD licensed to and operated by the licensee;
(B) The licensee submits false or
person with five percent or greater direct or indirect ownership in the AFH-DD
did not submit timely and accurate information on the Medicaid Provider
Enrollment Agreement form or fails to submit fingerprints if required under the
background check rules in OAR 407-007-0200
(D) Any person with five percent or greater
direct or indirect ownership interest in the AFH-DD has been convicted of a
criminal offense related to his or her involvement with Medicare, Medicaid, or
Title XXI programs in the last 10 years; or
(E) Any person with an ownership or control
interest, or who is an agent or managing employee of the AFH-DD fails to submit
timely and accurate information on the Medicaid Provider Enrollment Agreement
(j) If a licensee
submits notice of termination of the Medicaid Provider Enrollment Agreement,
the licensee must concurrently issue a Notice of Involuntary Move or Transfer
to each individual eligible for Medicaid services residing in the AFH-DD.
(k) If either a licensee or the
Department terminates the Medicaid Provider Enrollment Agreement, the licensee
may not re-apply for a new Medicaid Provider Enrollment Agreement for a period
of no less than 180 days from the date the licensee or the Department
terminated the Agreement.
licensee must forward all of the personal incidental funds (PIF) of an
individual who is a recipient of Medicaid services within 10 business days of
the death of the individual to the Estate Administration Unit, PO Box 14021,
Salem, Oregon 97309-5024.
PRIVATE PAY CONTRACT. A licensee who
provides care and services to support individuals who pay with private funds or
individuals receiving only day care services must enter into a written contract
with the individual or the person paying for the care and services of the
individual. The written contract is the admission agreement. The written
contract must be signed by all parties prior to the admission of the individual
and updated as needed. A copy of the contract is subject to review by the
Department prior to licensure and prior to the implementation of any changes to
The contract must include
but not be limited to:
(A) A person-centered
(B) A schedule of
(C) Conditions under
which the rates may be changed.
(b) The provider must give a copy of the
signed contract to the individual, or as applicable the legal representative of
the individual and retain the original contract in the record for the
(c) The licensee must
give written notice to a private pay individual, or as applicable the person
paying for the care and services of the individual, 30 days prior to any
general rate increases, additions, or other modifications of the rates unless
the change is due to a medical emergency resulting in a greater level of care
in which case the notice must be given within 10 days of the change.
The licensee must enter into a written
Residency Agreement with each individual specifying, at a minimum, the
(A) The eviction process, notice
requirements, and appeal rights available to each individual;
(B) The right of the individual to furnish
and decorate his or her bedroom, subject to the limitations specified herein;
Policies and conditions
for the following:
areas. Use of tobacco must be in compliance with the Oregon Indoor Clean Air
Act and OAR 411-360-0130
and presence of medical marijuana in compliance with the Oregon Medical
Marijuana Act and OAR 411-360-0140
. The Residency Agreement expectations for
medical marijuana must be reviewed and approved by the Department. If an
individual intends to use medical marijuana in the AFH-DD, the Residency
Agreement including guidelines for medical marijuana must be signed and dated
by the individual or the legal representative of the individual and included in
the record for the individual;
(iii) Restriction related to pets, if any;
(iv) Monthly charges and services
to be provided; and
(v) Refunds in
case of departure or death.
The Residency Agreement may not violate
the rights of an individual as stated in ORS
, OAR 411-360-0170
(c) The Residency
Agreement may not be in conflict with any of these rules or the rules in OAR
chapter 411, division 004 for home and community-based services and settings.
(d) Prior to implementing changes
to the Residency Agreement, the Residency Agreement may be subject to review by
the Department or the designee of the Department.
(e) The provider must review and provide a
copy of the Residency Agreement to each individual, and as applicable the legal
representative of the individual, at the time of entry and annually or as
changes occur. The reviews must be documented by having the individual, or as
applicable the legal representative of the individual, sign and date a copy of
the Residency Agreement. A copy of the signed and dated Residency Agreement
must be maintained in the record for the individual.