Oregon Administrative Rules › Chapter 411 - DEPARTMENT OF HUMAN SERVICES, AGING AND PEOPLE WITH DISABILITIES AND DEVELOPMENTAL DISABILITIES › Division 360 - ADULT FOSTER HOMES FOR INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES › Section 411-360-0055 - Provider Enrollment Agreements, Contracts, and Residency Agreements

Current through Register Vol. 63, No. 7, July 1, 2024
(1) MEDICAID
			 PROVIDER ENROLLMENT AGREEMENT.
(a) An
			 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
			 Management).
(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.
(h) The
			 Department may terminate a Medicaid Provider Enrollment Agreement under the
			 following circumstances:
(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.
(i) 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
			 inaccurate information;
(C) Any
			 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 to
			 407-007-0370;
(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
			 form.
(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.
(l) A
			 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.