Or. Admin. Code § 411-380-0070 - Provider Disenrollment and Termination
(1) Enrolled Medicaid providers may be denied
enrollment, terminated, or prohibited from providing direct nursing services
for any of the following:
(a) Violation of
any part of these rules.
(b) A
founded report of child abuse or substantiation of a violation of the
protective service and abuse rules in OAR chapter 411, division 020 or OAR
chapter 419, division 100.
(c) Any
sanction or action as a result of an investigation of the Oregon State Board of
Nursing.
(d) Failure to keep
required licensure or certifications current.
(e) Failure to provide copies of the records
described in these rules to OHA, the Department, or case management
entity.
(f) Failure to participate
in the review of the Nursing Service Plan or care coordination meetings when
requested by the case management entity.
(g) Failure to provide services.
(h) Fraud or misrepresentation in the
provision of direct nursing services.
(i) Evidence of conduct derogatory to the
standards of nursing as described in OAR
851-045-0070 that results in
referral to the Oregon State Board of Nursing.
(j) A demonstrated pattern of repeated
unsubstantiated complaints of neglect or abuse per OAR chapter 411, division
020 or OAR chapter 419, division 100.
(k) The provider is listed in the exclusions
database of the Office of the Inspector General.
(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) An enrolled
Medicaid provider of direct nursing services must provide advance written
notice to the Department and any individuals the provider is delivering direct
nursing services to at least 30 days prior to no longer providing direct
nursing services.
Notes
Statutory/Other Authority: ORS 409.050, 413.085 & 427.104
Statutes/Other Implemented: ORS 409.010, 413.085, 427.007 & 427.104
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