Or. Admin. Code § 411-375-0070 - Inactivation and Termination of Independent Providers
(1) An independent provider is not paid for
work performed while their provider number is inactivated, inactivated in an
emergency, or terminated.
(2)
STANDARD INACTIVATION. The Department may inactivate a provider number for an
independent provider for any of the following reasons until the independent
provider takes action to reinstate their provider enrollment:
(a) The independent provider informs the case
management entity the independent provider is no longer providing services in
Oregon.
(b) For a personal support
worker, the personal support worker fails to participate in a required
orientation for personal support workers as described in the Collective
Bargaining Agreement.
(c) The
background check for an independent provider results in a closed case pursuant
to OAR 407-007-0320.
(d) More than two years have passed since the
date on the most recent background check final fitness determination for an
independent provider.
(e) More than
two years have passed since the signature date on the most recent Provider
Enrollment Application and Agreement for an independent provider.
(f) The independent provider fails to
participate in training required by the Department.
(g) The independent provider does not request
a hearing within 10 business days of a notice of proposed
termination.
(h) For a personal
support worker, the personal support worker has not provided any paid services
to any individual in the last 18 months.
(3) EMERGENCY INACTIVATION. The Department
may immediately inactivate the provider number for an independent provider for
any of the following reasons:
(a) The
independent provider, whether or not providing any paid services to an
individual, is being investigated for any alleged violation of the protective
service and abuse rules for suspected abuse that poses imminent danger to
current or future individuals.
(b)
The independent provider, whether or not providing any paid services to an
individual, is being investigated by law enforcement for a crime listed in ORS
443.004.
(c) The independent provider has a credible
allegation of fraud according to
42 CFR
455.23.
(d) The independent provider knowingly
engages in activities that may result in exposure of an individual to the
Coronavirus (COVID-19).
(A) Activities
include:
(i) For an independent provider
residing with an individual, failure to take reasonable measures to prevent
transmittal of COVID-19 as directed by a health care provider or the Local
Public Health Authority.
(ii) For
an independent provider not residing with an individual, having in-person
contact with the individual while:
(I)
Diagnosed with COVID-19 or presumed to have COVID-19 as directed by a health
care provider or the Local Public Health Authority;
(II) Advised to self-quarantine;
(III) Subject to a quarantine or isolation
order; or
(IV) Symptomatic as
described in subsection (B)(ii) of this section.
(B) The provider number may be
immediately inactivated in the following circumstances:
(i) Activities resume sooner than 14 calendar
days after an independent provider has been:
(I) Diagnosed with COVD-19 or presumed to
have COVID-19 as directed by a health care provider or the Local Public Health
Authority;
(II) Advised by a health
care provider to self-quarantine; or
(III) Subject to a quarantine or isolation
order by a health care provider or the Local Public Health Authority.
(ii) Activities resume sooner than
72 hours after an independent provider is symptomatic. Symptoms include, but
are not limited to, the following:
(I) Fever
or chills.
(II) Cough.
(III) Shortness of breath or difficulty
breathing.
(IV) Fatigue.
(V) Muscle or body aches.
(VI) Headache.
(VII) New loss of taste or smell.
(VIII) Sore throat.
(IX) Congestion or runny nose.
(4) EMERGENCY INACTIVATION ORDER. The
Department shall issue a written order of emergency inactivation of a provider
number to the independent provider when the emergency inactivation is based on
section (3) of this rule.
(a) The
Department-issued emergency inactivation order must include the following:
(A) Findings of the specific act or omission
of the independent provider that violates applicable laws or rules and is the
grounds for emergency inactivation.
(B) The reasons the specified act or omission
presents imminent danger to individuals.
(C) A reference to the law or rule involved,
including specific sections and subsections.
(D) The hearing rights as described in OAR
411-375-0080, including the
right to legal representation, if applicable, where to file a hearing request,
and the right of the independent provider to request that a hearing be held as
soon as practicable to contest the emergency inactivation order. The request
for a hearing must be received by the Department within 90 calendar days of the
date of the emergency inactivation order or the independent provider shall
waive the right to a hearing regarding the emergency inactivation
order.
(E) The effective date of
the emergency inactivation.
(b) Service of the emergency inactivation
order must be accomplished either by personal service, or service by registered
or certified mail.
(5)
TERMINATION. The Department may terminate the provider number for an
independent provider for any of the following reasons:
(a) The independent provider violates the
requirement to maintain a drug-free work place by either of the following:
(A) Being intoxicated by alcohol, inhalants,
prescription drugs, or other drugs, including over-the-counter medications,
while responsible for the care of an individual, while in the home of the
individual, or while transporting the individual; or
(B) Manufacturing, possessing, selling,
offering to sell, trading, or using illegal drugs while providing authorized
services to an individual or while in the home of the individual.
(b) The independent provider has
an unacceptable background check and the background check results in a closed
case pursuant to OAR 407-007-0320.
(c) The independent provider demonstrates a
lack of skills, knowledge, or ability to adequately or safely provide services
as defined in OAR 411-375-0010.
(d) The independent provider has a violation
of the protective service and abuse rules as defined in OAR
411-375-0010.
(e) Notwithstanding abuse as defined in OAR
411-317-0000, OAR
419-100-0010, OAR
411-020-0002, or child abuse as
defined in OAR 413-015-0115, the independent
provider fails to safely and adequately provide authorized services.
(f) The independent provider commits fiscal
improprieties including, but not limited to, billing excessive or fraudulent
charges or has a conviction for fraud according to
42 CFR
455.23.
(g) The independent provider fails to provide
services to an individual as described in the individual's Service Agreement or
ISP.
(h) The independent provider
lacks the ability or willingness to maintain individual
confidentiality.
(i) The
independent provider engages in repeated unacceptable conduct at work, such as
the following:
(A) Delay in arriving to work
or absences from work not scheduled in advance with the individual, or as
applicable their legal or designated representative, that are either
unsatisfactory to the individual, or as applicable their legal or designated
representative, or that neglect the service needs of the individual;
or
(B) Inviting unwelcome guests or
pets into the home or community with the individual resulting in the
dissatisfaction of the individual, or as applicable their legal or designated
representative, or inattention to the service needs of the
individual.
(j) The
independent provider has been excluded or debarred by the Office of the
Inspector General.
(k) The
independent provider fails to perform the applicable duties as a mandatory
reporter as required by any of the following:
(A) ORS
419B.010 and
419B.015 for abuse of a
child.
(B) ORS
124.060 and
124.065 for abuse of an older
adult 65 years of age or older.
(C)
ORS 430.737 and
430.743 for abuse of an adult
with an intellectual or developmental disability or mental illness.
(D) ORS
441.640 and
441.645 for abuse of a resident
of a long-term care facility as defined in ORS
442.015.
(l) The independent provider fails to provide
a Taxpayer Identification Number or Social Security number that matches the
legal name of the independent provider as verified by the Internal Revenue
Service or Social Security Administration.
(m) The independent provider fails to
complete training required by the Department as a condition of retaining their
provider number due to a violation of these rules.
(n) The independent provider has been
suspended or terminated as a provider by another division within the Department
or by the Oregon Health Authority.
(o) Notwithstanding abuse as defined in OAR
411-317-0000, OAR
419-100-0010, OAR
411-020-0002, or child abuse as
defined in OAR 413-015-0115, the independent
provider either:
(A) Uses a safeguarding
intervention or safeguarding equipment as a restraint without training in an
ODDS-approved behavior intervention system.
(B) Uses a safeguarding intervention or
safeguarding equipment as a restraint not meeting the standards in OAR
411-375-0035.
(p) After April 1, 2020, the
personal support worker repeatedly fails to utilize the Electronic Visit
Verification interface for eXPRS to record hours worked without an approved
exception.
(q) The independent
provider knowingly engages in activities that may result in exposure of an
individual to the Coronavirus (COVID-19).
(A)
Activities include:
(i) For an independent
provider residing with an individual, failure to take reasonable measures to
prevent transmittal of COVID-19 as directed by a health care provider or the
Local Public Health Authority.
(ii)
For an independent provider not residing with an individual, having in-person
contact with the individual while:
(I)
Diagnosed with COVID-19 or presumed to have COVID-19 as directed by a health
care provider or the Local Public Health Authority;
(II) Advised to self-quarantine;
(III) Subject to a quarantine or isolation
order; or
(IV) Symptomatic as
described in subsection (B)(ii) of this section.
(B) The provider number may be
terminated in the following circumstances:
(i)
Activities resume sooner than 14 calendar days after an independent provider
has been:
(I) Diagnosed with COVD-19 or
presumed to have COVID-19 as directed by a health care provider or the Local
Public Health Authority;
(II)
Advised by a health care provider to self-quarantine; or
(III) Subject to a quarantine or isolation
order by a health care provider or the Local Public Health Authority.
(ii) Activities resume sooner than
72 hours after an independent provider is symptomatic. Symptoms include, but
are not limited to, the following:
(I) Fever
or chills.
(II) Cough.
(III) Shortness of breath or difficulty
breathing.
(IV) Fatigue.
(V) Muscle or body aches.
(VI) Headache.
(VII) New loss of taste or smell.
(VIII) Sore throat.
(IX) Congestion or runny nose.
(r) The
personal support worker works hours in excess of those permitted by OAR
411-375-0040(5)(d)
unless the personal support worker:
(A) Must
exceed the limits imposed by OAR
411-375-0040(5)(d)
to ensure the health and safety of an individual during an emergency or urgent
situation; and
(B) Immediately
notifies the individual's case manager. In the case of an emergency that occurs
after local office hours, the personal support worker must notify the case
manager within two business days.
(6) NOTIFICATION OF PROPOSED TERMINATION. The
Department must issue a written notice of the proposed termination of a
provider number to the independent provider when the termination is based on
section (5) of this rule.
(a) For
terminations based on a violation of the protective service and abuse rules,
the written notice of termination may only contain the information allowed by
law. In accordance with ORS
430.753,
430.763, and OAR
411-020-0030, the name of a
complainant, witness, or alleged victim, and protected health information may
not be disclosed.
(b) The
Department-issued written notice of the proposed termination must include the
following:
(A) Findings of the specific act
or omission of the independent provider that violates applicable laws or rules
and is the grounds for termination.
(B) A reference to the law or rule involved,
including specific sections and subsections.
(C) The hearing rights, if any, of the
independent provider as described in OAR
411-375-0080, including the
right to legal representation, if applicable, and where to file a request for
hearing.
(D) The effective date of
the termination.
(c)
Service of the notification of proposed termination must be accomplished either
by personal service, or service by registered or certified mail.
(7) RETENTION OF PROVIDER NUMBER
PENDING TERMINATION HEARING OUTCOME.
(a)
Unless an independent provider is immediately inactivated as described in
section (3) of this rule, the provider number of an independent provider may
not be inactivated during the first 10 business days after a notice of proposed
termination to provide the opportunity for the independent provider to file a
request for hearing.
(A) The independent
provider must file a request for hearing within 10 business days from the date
of the notice of proposed termination if the independent provider wishes to
continue to work during the hearing process as described in OAR
411-375-0080.
(B) If the independent provider files a
written request for a hearing prior to the deadline, the provider number of the
independent provider may not be terminated until the hearing process is
concluded.
(b)
EXCLUSIONS. An independent provider may be terminated immediately by the
Department for any of the following reasons and the independent provider may
not continue to work during the hearing process as described in OAR
411-375-0080 when termination is
based on the following:
(A) A background
check. The independent provider has the right to a hearing in accordance with
OAR 407-007-0200 to
407-007-0370.
(B) Being excluded or debarred by the Office
of the Inspector General.
(C) A
conviction for fraud according to
42 CFR
455.23.
(D) An alleged violation listed in section
(5) of this rule and the alleged violation presents imminent danger to current
or future individuals.
(8) TERMINATION IF NO HEARING REQUEST FILED.
(a) An independent provider must file a
request for hearing as described in OAR
411-375-0080 within 30 calendar
days from the date of the notice of proposed termination.
(b) The decision of the Department becomes
final if an independent provider does not request a hearing within 30 calendar
days from the date of the notice of proposed termination.
(c) The Department shall issue a final order
by default to the independent provider in accordance with OAR
137-003-0670. The provider
enrollment for the independent provider is terminated once the time period for
the independent provider to request a hearing has expired.
Notes
Statutory/Other Authority: ORS 409.050
Statutes/Other Implemented: ORS 409.010, 410.600, 410.606-410.619 & 427.007
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