Or. Admin. Code § 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.
Notes
Statutory/Other Authority: ORS 409.050 & 410.070
Statutes/Other Implemented: ORS 409.010 & 410.070
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