Oregon Administrative Rules › Chapter 407 - DEPARTMENT OF HUMAN SERVICES › Division 120 - PROVIDER RULES › Section 407-120-0325 - Compliance with Federal and State Statutes

Current through Register Vol. 63, No. 7, July 1, 2024
(1) When a provider submits a claim for
			 services or supplies provided to a Department client, the Department shall
			 consider the submission as the provider's representation to the Department of
			 the provider's compliance with the applicable sections of the federal and state
			 statutes and rules referenced in this rule, and other program rules or contract
			 requirements of the specific program under which the claim is submitted:
(a)  45 CFR Part 84  which implements Title V,
			 Section 504 of the Rehabilitation Act of 1973;
(b)  42 CFR Part 493  Laboratory Requirements
			 and ORS chapter 438 (Clinical Laboratories).
(c) The provider must comply and, as
			 indicated, require all subcontractors to comply with the following federal and
			 state requirements to the extent that they are applicable to the items and
			 services governed by these rules, unless exempt under  45 CFR Part 87  for
			 Faith-Based Organizations (Federal Register, July 16, 2004, Volume 69, #136),
			 or other federal provisions. For purposes of these rules, all references to
			 federal and state laws are references to federal and state laws as they may be
			 amended from time to time that are in effect on the date of provider's service:
(A) The provider must comply and require all
			 subcontractors to comply with all federal laws, regulations, executive orders
			 applicable to the items and services provided under these rules. Without
			 limiting the generality of the foregoing, the provider expressly agrees to
			 comply and require all subcontractors to comply with the following laws,
			 regulations and executive orders to the extent they are applicable to the items
			 and services provided under these rules:
(i)
			 Title VI and VII of the Civil Rights Act of 1964, as amended;
(ii) Sections 503 and 504 of the
			 Rehabilitation Act of 1973, as amended;
(iii) The Americans with Disabilities Act of
			 1990, as amended;
(iv) Executive
			 Order 11246, as amended;
(v) The
			 Health Insurance Portability and Accountability Act of 1996;
(vi) The Age Discrimination in Employment Act
			 of 1967, as amended, and the Age Discrimination Act of 1975, as
			 amended;
(vii) The Vietnam Era
			 Veterans' Readjustment Assistance Act of 1974, as amended, (viii) all
			 regulations and administrative rules established pursuant to the foregoing
			 laws;
(viii) All other applicable
			 requirements of federal civil rights and rehabilitation statutes, rules, and
			 regulations;
(ix) All federal law
			 governing operation of community mental health programs, including without
			 limitation, all federal laws requiring reporting of client abuse. These laws,
			 regulations and executive orders are incorporated by reference herein to the
			 extent that they are applicable to the items and services governed by these
			 rules and required by law to be so incorporated. No federal funds may be used
			 to provide services in violation of
			 42
			 USC 14402.
(B) Any provider that receives or makes
			 annual payments under Medicaid of at least $5,000,000, as a condition of
			 receiving such payments, shall:
(i) Establish
			 written policies for all employees of the entity (including management), and of
			 any contractor, subcontractor, or agent of the entity, that provide detailed
			 information about the False Claims Act established under
			 31
			 USC 3729 through
			 3733,
			 administrative remedies for false claims and statements established under  31
			 USC 38, any Oregon state laws pertaining to civil or criminal penalties for
			 false claims and statements, and whistle blowing protections under such laws,
			 with respect to the role of such laws in preventing and detecting fraud, waste,
			 and abuse in Federal health care programs (as defined in
			 42
			 USC 1320a - 7b(f));
(ii) Include as part of written policies,
			 detailed provisions regarding the entity's policies and procedures for
			 detecting and preventing fraud, waste, and abuse; and
(iii) Include in any employee handbook for
			 the entity, a specific discussion of the laws described in sub-paragraph (i),
			 the rights of the employees to be protected as
			 whistleblowers.
(C) If
			 the items and services governed under these rules exceed $10,000, the provider
			 must comply and require all subcontractors to comply with Executive Order
			 11246, entitled "Equal Employment Opportunity," as amended by Executive Order
			 11375, and as supplemented in U.S Department of Labor regulations (41 CFR part
			 60);
(D) If the items and services
			 governed under these rules exceed $100,000, and are paid in any part with
			 federal funds, the provider must comply and require all subcontractors to
			 comply with all applicable standards, orders, or requirements issued under
			 Section 306 of the Clean Air Act (42 U.S.C.
			 7606), the Federal Water Pollution Control
			 Act as amended (commonly known as the Clean Water Act --
			 33 U.S.C.
			 1251 to
			 1387), specifically including, but not limited to, Section 508 (33 U.S.C.
			 1368). Executive Order 11738, and
			 Environmental Protection Agency regulations ( 40 CFR Part 32), which prohibit
			 the use under non-exempt Federal contracts, grants or loans of facilities
			 included on the EPA List of Violating Facilities. Violations must be reported
			 to the Department, DHHS, and the appropriate Regional Office of the
			 Environmental Protection Agency. The provider must include and require all
			 subcontractors to include in all contracts with subcontractors receiving more
			 than $100,000, language requiring the subcontractor to comply with the federal
			 laws identified in this section;
(E) The provider must comply and require all
			 subcontractors to comply with applicable mandatory standards and policies
			 relating to energy efficiency that are contained in the Oregon energy
			 conservation plan issued in compliance with the Energy Policy and Conservation
			 Act,
			 42 U.S.C.
			 6201 et seq. ( Pub. L. 94-163);
(F) The provider must provide written
			 certification indicating that:
(i) No federal
			 appropriated funds have been paid or shall be paid, by or on behalf of the
			 provider, to any person for influencing or attempting to influence an officer
			 or employee of an agency, a Member of Congress, an officer or employee of
			 Congress, or an employee of a Member of Congress in connection with the
			 awarding of any federal contract, the making of any federal grant, the making
			 of any federal loan, the entering into of any cooperative agreement, and the
			 extension, continuation, renewal, amendment or modification of any federal
			 contract, grant, loan or cooperative agreement;
(ii) If any funds other than federal
			 appropriated funds have been paid or shall be paid to any person for
			 influencing or attempting to influence an officer or employee of any agency, a
			 Member of Congress, an officer or employee of Congress, or an employee of a
			 Member of Congress in connection with this federal contract, grant, loan or
			 cooperative agreement, the provider must complete and submit Standard Form LLL,
			 "Disclosure Form to Report Lobbying" in accordance with its
			 instructions;
(iii) The provider
			 must require that the language of this certification be included in the award
			 documents for all sub-awards at all tiers (including subcontracts, sub-grants,
			 and contracts under grants, loans, and cooperative agreements) and that all
			 sub-recipients and subcontractors must certify and disclose
			 accordingly;
(iv) This
			 certification is a material representation of fact upon which reliance was
			 placed when this provider agreement was made or entered into. Submission of
			 this certification is a prerequisite for making or entering into this provider
			 agreement imposed by
			 31
			 USC 1352. Any person who fails to file the
			 required certification shall be subject to a civil penalty of not less than
			 $10,000 and not more than $100,000 for each such failure.
(G) If the items and services funded in whole
			 or in part with financial assistance provided under these rules are covered by
			 HIPAA or the federal regulations implementing HIPAA, the provider agrees to
			 deliver the goods and services in compliance with HIPAA. The provider must
			 comply and require all subcontractors to comply with the following:
(i) Individually identifiable health
			 information about specific individuals is confidential. Individually
			 identifiable health information relating to specific individuals may be
			 exchanged between the provider and the Department for purposes directly related
			 to the provision to clients of services that are funded in whole or in part
			 under these rules. The provider must not use or disclose any individually
			 identifiable health information about specific individuals in a manner that
			 would violate Department privacy rules, (OAR 410-014-0000  et. seq.), or the
			 Department's Notice of Privacy Practices, if done by the Department;
(ii) Providers who engage in EDI transactions
			 with the Department in connection with claims or encounter data, eligibility or
			 enrollment information, authorizations or other electronic transactions must
			 execute an EDI trading partner agreement with the Department and must comply
			 with the Department's electronic data transmission rules (OAR 407-120-0100  to
			 407-120-0200);
(iii) If a provider
			 reasonably believes that the provider's or the Department's data transactions
			 system or other application of HIPAA privacy or security compliance policy may
			 result in a violation of HIPAA requirements, the provider must promptly consult
			 the Department's privacy officer. The provider or the Department may initiate a
			 request to test HIPAA transactions, subject to available resources and the
			 Department's testing schedule.
(H) The provider must comply and require all
			 subcontractors to comply with all mandatory standards and policies that relate
			 to resource conservation and recovery pursuant to the Resource Conservation and
			 Recovery Act (codified at
			 42 USC
			 6901 et. seq.). Section 6002 of that Act
			 (codified at
			 42 USC 6962) 
			 requires that preference be given in procurement programs to the purchase of
			 specific products containing recycled materials identified in guidelines
			 developed by the Environmental Protection Agency. Current guidelines are set
			 forth in 40 CFR Parts 247;
(I) The
			 provider must comply and require all subcontractors to comply with the
			 applicable audit requirements and responsibilities set forth in the Office of
			 Management and Budget Circular A-133 entitled "Audits of States, Local
			 Governments and Non-Profit Organizations;"
(J) The provider must not permit any person
			 or entity to be a subcontractor if the person or entity is listed on the
			 non-procurement portion of the General Service Administration's "List of
			 Parties Excluded from Federal Procurement or Nonprocurement Programs" in
			 accordance with Executive Orders No. 12,549 and No. 12,689, "Debarment and
			 Suspension". (See  45 CFR part 76). This list contains the names of parties
			 debarred, suspended, or otherwise excluded by agencies, and providers and
			 subcontractors declared ineligible under statutory authority other than
			 Executive Order No. 12549. Subcontractors with awards that exceed the
			 simplified acquisition threshold must provide the required certification
			 regarding their exclusion status and that of their principals prior to
			 award;
(K) The provider must comply
			 and require all subcontractors to comply with the following provisions to
			 maintain a drug-free workplace:
(i) Certify
			 that it shall provide a drug-free workplace by publishing a statement notifying
			 its employees that the unlawful manufacture, distribution, dispensation,
			 possession, or use of a controlled substance, except as may be present in
			 lawfully prescribed or over-the-counter medications, is prohibited in the
			 provider's workplace or while providing services to Department clients. The
			 provider's notice must specify the actions that shall be taken by the provider
			 against its employees for violation of such prohibitions;
(ii) Establish a drug-free awareness program
			 to inform its employees about the dangers of drug abuse in the workplace, the
			 provider's policy of maintaining a drug-free workplace, any available drug
			 counseling, rehabilitation, and employee assistance programs, and the penalties
			 that may be imposed upon employees for drug abuse violations;
(iii) Provide each employee to be engaged in
			 the performance of services under these rules a copy of the statement required
			 in paragraph (J)(i) above;
(iv)
			 Notify each employee in the statement required by paragraph (J)(i) that, as a
			 condition of employment to provide services under these rules, the employee
			 shall abide by the terms of the statement and notify the employer of any
			 criminal drug statute conviction for a violation occurring in the workplace no
			 later than five days after such conviction;
(v) Notify the Department within ten days
			 after receiving notice under subparagraph (J)(iv) from an employee or otherwise
			 receiving actual notice of such conviction;
(vi) Impose a sanction on, or require the
			 satisfactory participation in a drug abuse assistance or rehabilitation program
			 by any employee who is convicted as required by Section 5154 of the Drug-Free
			 Workplace Act of 1988;
(vii) Make a
			 good-faith effort to continue a drug-free workplace through implementation of
			 subparagraphs (J)(i) through (J)(vi);
(viii) Require any subcontractor to comply
			 with subparagraphs (J)(i) through (J)(vii);
(ix) The provider, the provider's employees,
			 officers, agents, or subcontractors shall not provide any service required
			 under these rules while under the influence of drugs. For purposes of this
			 provision, "under the influence" means observed abnormal behavior or
			 impairments in mental or physical performance leading a reasonable person to
			 believe the provider or provider's employee, officer, agent, or subcontractor
			 has used a controlled substance, prescription, or non-prescription medication
			 that impairs the provider or provider's employee, officer, agent, or
			 subcontractor's performance of essential job function or creates a direct
			 threat to Department clients or others. Examples of abnormal behavior include
			 but are not limited to hallucinations, paranoia or violent outbursts. Examples
			 of impairments in physical or mental performance include but are not limited to
			 slurred speech, difficulty walking or performing job activities;
(x) Violation of any provision of this
			 subsection may result in termination of the provider agreement.
(L) The provider must
			 comply and require all sub-contractors to comply with the Pro-Children Act of
			 1994 (codified at  20 USC section 6081  et. seq.);
(M) A provider reimbursed or seeking
			 reimbursement with Medicaid funds must comply with all applicable federal and
			 state laws and regulations pertaining to the provision of Medicaid services
			 under the Medicaid Act, Title XIX,  42 USC Section 1396  et. seq., including
			 without limitation:
(i) Maintain necessary
			 records to fully disclose the extent of the services provided to individuals
			 receiving Medicaid assistance and must furnish the information to any state or
			 federal agency responsible for administering the Medicaid program regarding any
			 payments claimed by the provider or institution for providing Medicaid services
			 as the state or federal agency may from time to time request.  42 USC Section 1396  a(a)(27);
			 42 CFR
			 431.107(b)(1) &
			 (2);
(ii) Comply with all
			 disclosure requirements of
			 42 CFR
			 1002.3(a) and  42 CFR 455
			  Subpart (B);
(iii) Maintain written
			 notices and procedures respecting advance directives in compliance with  42 USC Section 1396 (a)(57) and (w),
			 42 CFR
			 431.107(b)(4), and  42 CFR
			 489  subpart I;
(iv) Certify when
			 submitting any claim for the provision of Medicaid services that the
			 information submitted is true, accurate and complete. The provider must
			 acknowledge provider's understanding that payment of the claim shall be from
			 federal and state funds and that any falsification or concealment of a material
			 fact may be prosecuted under federal and state laws.
(N) Providers must comply with the
			 obligations intended for contractors under ORS
			 279B.220,
			 279B.225,
			 279B.230 and
			 279B.235 (if applicable),
			 Providers shall, to the maximum extent economically feasible in the performance
			 of covered services, use recycled paper (as defined in ORS
			 279A.010(1)(ee)),
			 recycled PETE products (as defined in
			 279A.010(1)(ff)),
			 and other recycled plastic resin products and recycled products (as "recycled
			 product" is defined in
			 279A.010(1)(gg)).
(O) Providers must comply with all
			 federal, state and local tax laws, including Social Security payment
			 requirements, applicable to payments made by the Department to the
			 provider.