Oregon Administrative Rules › Chapter 410 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: MEDICAL ASSISTANCE PROGRAMS › Division 172 - MEDICAID PAYMENT FOR BEHAVIORAL HEALTH SERVICES › Section 410-172-0820 - Provider Enrollment Termination

Current through Register Vol. 63, No. 7, July 1, 2024
(1) The Authority may take action, including
			 denial, suspension or termination, on a personal care attendant's provider
			 enrollment or re-enrollment, and the provider number as described in OAR
			 Chapter 410 Division 120. The termination, suspension, and appeal rights for
			 Personal Care Attendants are described in OAR 410-120-1560  through
			 410-120-1600.
(2) Immediate
			 termination of a PCA will be determined by the Division based on reasonable
			 cause to believe there is an imminent danger to current or future consumers. If
			 there is good cause to believe that an individual's life, physical, emotional,
			 or financial well-being is at risk, the Division will issue a Notification of
			 Immediate Sanction to the PCA that may result in termination and prepare any
			 necessary documents to support the decision should the PCA requests a
			 hearing.
(3) The Authority may deny
			 or terminate a PCA provider enrollment and provider number when the PCA:
(a) Has been appointed the representative of
			 an individual they are employed by or found to be a spouse or legal
			 representative of the individual they are employed by;
(b) Fails to obtain a background check as
			 requested by the Authority or has a background check at any time that results
			 in an adverse fitness determination pursuant to OAR chapter 943, division
			 007;
(c) Lacks the skills,
			 knowledge, or ability to perform the required work as described in these rules
			 and OAR chapter 418, division, 020;
(d) Forged or otherwise falsified one or more
			 credentials, education or training documentation, or other records submitted to
			 Authority to obtain approval as a qualified provider;
(e) Violates the protective service and abuse
			 rules described in OAR Chapter 413, division 15, OAR chapter 411, division 20,
			 and OAR chapter 407, division 45;
(f) Commits one or many Fiscal Improprieties
			 as defined in OAR 410-172-0776, one time or as a pattern of behavior;
(g) Fails to provide the authorized personal
			 care services. Coerces or colludes with the individual to sign or approve
			 false, blank or inaccurate timesheets or document false or inaccurate
			 information in the EVV system;
(h)
			 Fails to arrive and depart work at a date and time documented in the work
			 schedule authorized by the individual;
(i) Fails to maintain a drug-free
			 workplace;
(j) Has been or is
			 currently excluded as a provider by the U.S. Department of Health and Human
			 Services, Office of Inspector General from participation in Medicaid, Medicare,
			 or any other state or federal health care programs;
(k) Has been sanctioned or convicted of a
			 felony or misdemeanor related to a crime, or violation of Title XVIII, XIX, or
			 XX of the Social Security Act, or related state laws;
(l) Fails to maintain confidentiality,
			 security and privacy of protected health information, as required by HIPAA and
			 State privacy laws;
(m) Exerts
			 undue influence, including coercion, over an individual or their
			 consumer-employer representative;
(n) Introduces or creates an unwelcome
			 nuisance to the workplace as determined by the individual;
(o) Fails to perform the duties of a
			 mandatory reporter in ORS
			 419B.010 and ORS
			 430.765;
(p) Fails to inform the Division and their
			 consumer-employer within 14 days of being arrested, cited for, or convicted of
			 any potentially disqualifying crime listed in OAR 125-007-0270;
(q) fails to meet one or more of the
			 mandatory training and competency evaluation requirements described in OAR
			 418-020-0035;
(r) Is an employee
			 with the State of Oregon;
(s) Fails
			 to adhere to the hourly cap described in the CBA or to the service limitations
			 in the BH PCA authorization, service plan and State Plan Amendment;
(t) Knowingly engages in activities that may
			 pose risks to the health and safety of an eligible individual, or others in the
			 community, including exposure to an infectious disease;
(u) Engages in discrimination of others based
			 on race, national origin, color, sex, gender identity, sexual orientation, age,
			 religion, physical, intellectual, developmental, or mental disability, military
			 status, or marital or family status and as described in OAR
			 410-120-1380(1)(c)(A);
(v) Offers
			 medically unnecessary services or more services than necessary to the eligible
			 individual;
(w) Knowingly submits
			 or causes to be submitted information or documents that contain inaccurate,
			 misleading, or omitted information and such inaccurate, misleading, or omitted
			 information would result, or has resulted, in an overpayment.