Or. Admin. Code § 411-048-0210 - Qualifications for Enrolled Medicaid Providers
(1) The Department may determine the number
and type of enrolled Medicaid providers in a geographic area to assure that
there is an appropriate number of qualified enrolled Medicaid providers to meet
the needs of individuals eligible for long term care community nursing
services.
(2) The Department shall
select qualified enrolled Medicaid providers for long term care community
nursing services according to the standards in these rules, OAR
407-120-0320, and OAR chapter
410, division 120 as applicable.
(3) The long term care community nursing
services provided under these rules may be delivered by the following enrolled
Medicaid providers:
(a) An RN who is a
self-employed provider.
(b) Home
health agencies meeting the requirements in OAR chapter 333, division
027.
(c) In-home care agencies
meeting the requirements in OAR chapter 333, division 536.
(4) A self-employed RN who enrolls with the
Department to provide long term care community nursing services under these
rules must:
(a) Pass a background check as
defined in OAR 407-007-0200 to
407-007-0370 and OAR
407-007-0600 to
407-007-0640; and
(b) Provide and have available verification
of all of the following:
(A) A current and
unencumbered Oregon Registered RN license.
(B) Certification of professional liability
insurance and commercial general liability insurance with coverage that meets
Department requirements.
(C)
Documentation supporting qualifications and expertise:
(i) A minimum of two years full time or
equivalent verifiable experience practicing as an RN in an in-home, home
health, skilled nursing, hospital, or Department licensed community setting. At
least one of these two years must have occurred within three years of the date
the RN enrolls with the Department; and
(ii) One year experience with providing RN
delegation service in the last two years or
(iii) A pass score on the Department's test
on OSBN's OAR chapter 851, divisions 006, 045, and 047 to demonstrate
satisfactory experience and the skills necessary to perform the duties as
described under these rules.
(D) Contact information for people or
entities that verify the qualifications and expertise documented pursuant to
this section.
(5) Agencies listed in section (3)(b) and (c)
of this rule who enroll with the Department to provide long term care community
nursing services under these rules must:
(a)
Have a current and unencumbered Oregon license pursuant to OAR chapter 333,
division 027 or OAR chapter 333, division 536 and maintain compliance with
existing in home or home health agency licensing rules;
(b) Provide and have available verification
of all of the following:
(A) Policies and
procedures for the in home or home health agency to credential RNs before
hiring or contracting and recredential RNs at least every three years to ensure
each RN has and maintains a current and unencumbered Oregon RN license at all
times. The agency must maintain records of all credentialing and
recredentialing activities.
(B)
Certification of professional liability insurance and commercial general
liability insurance with coverage that meets Department requirements.
(C) Documentation verifying the qualification
and expertise of the RNs hired by the agency to provide long term care
community nursing services including:
(i)
Experience with the RN delegation process in the community-based
setting;
(ii) Contact information
for people or entities that verify the qualifications and experience documented
pursuant to this section; and
(iii)
A background check as defined in OAR
407-007-0200 to
407-007-0370 and OAR
407-007-0600 to
407-007-0640.
(D) Evidence of policies and procedures
ensuring that the agency and its employees follow the specific standards in OAR
chapter 411, division 048 and OAR chapter 410, division 120 (as applicable)
that may exceed OAR chapter 333, divisions 027 or 536.
Notes
Statutory/Other Authority: ORS 409.050 & 410.070
Statutes/Other Implemented: ORS 409.010 & 410.070
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