OAR 333-076-0117
ASC Surveys

(1) The Authority shall, in addition to any investigations conducted under OAR 333-076-0116 (ASC Investigations), conduct at least one on-site licensing survey of each ASC every three years to determine compliance with health care facility licensing laws and at such other times as the Authority deems necessary.
(2) In lieu of an onsite inspection required under section (1) of this rule, the Authority may accept:
(a) CMS certification by a federal agency or an approved accrediting organization; or
(b) A survey conducted within the previous three years by an accrediting organization approved by the Authority, if:
(A) The certification or accreditation is recognized by the Authority as addressing the standards and Condition for Coverage requirements of the CMS and other standards set by the Authority;
(B) The ASC notifies the Authority to participate in any exit interview conducted by the federal agency or accrediting body; and
(C) The ASC provides copies of all documentation concerning the certification or accreditation requested by the Authority including:
(i) Written evidence of all corrective actions underway, or completed, in response to approved accrediting organizations recommendations;
(ii) All progress reports; and
(iii) The letter from CMS indicating its deemed status.
(3) If the deemed status of an ASC changes, the ASC administrator must notify the Authority.
(4) An ASC shall permit Authority staff access to the facility during a survey.
(5) A survey may include but is not limited to:
(a) Interviews of patients, patient family members, ASC management and staff;
(b) On-site observations of patients, staff performance, and the physical environment of the ASC;
(c) Review of documents and records; and
(d) Patient audits.
(6) An ASC shall make all requested documents and records available to the surveyor for review and copying.
(7) Following a survey, Authority staff may conduct an exit conference with the ASC administrator or the administrator’s designee. During the exit conference Authority staff shall:
(a) Inform the ASC representative of the preliminary findings of the inspection; and
(b) Give the person a reasonable opportunity to submit additional facts or other information to the surveyor in response to those findings.
(8) Following the survey, Authority staff shall prepare and provide the ASC administrator or the administrator’s designee specific and timely written notice of the findings.
(9) If the findings result in a referral to another regulatory agency, Authority staff shall submit the applicable information to that referral agency for its review and determination of appropriate action.
(10) If no deficiencies are found during a survey, the Authority shall issue written findings to the ASC administrator indicating that fact.
(11) If deficiencies are found, the Authority shall take informal or formal enforcement action in accordance with OAR 333-076-0255 (ASC Informal Enforcement) or OAR 333-076-0260 (ASC Formal Enforcement).

Source: Rule 333-076-0117 — ASC Surveys, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-076-0117.

333‑076‑0001
Applicability 333‑076‑0095
Purpose 333‑076‑0101
Definitions 333‑076‑0102
Application for ASC License and Fees 333‑076‑0103
ASC Application Review 333‑076‑0104
Approval of ASC License Application 333‑076‑0107
Denial of ASC License Application 333‑076‑0108
Expiration and Renewal of ASC License 333‑076‑0110
Return of ASC License and ASC Closure 333‑076‑0111
ASC Classification 333‑076‑0114
ASC Complaints 333‑076‑0116
ASC Investigations 333‑076‑0117
ASC Surveys 333‑076‑0118
ASC Health Care Practitioner Credentialing 333‑076‑0119
ASC Governing Body Responsibility 333‑076‑0120
ASC Medical Staff 333‑076‑0125
ASC Personnel 333‑076‑0130
ASC Policies and Procedures 333‑076‑0135
ASC Nursing Services 333‑076‑0137
ASC Surgery Services 333‑076‑0140
ASC Anesthesia Services (If Provided) 333‑076‑0145
ASC Storage, Disposal and Dispensing of Drugs 333‑076‑0150
ASC Emergency Services 333‑076‑0155
ASC Laboratory Services 333‑076‑0160
Care of ASC Patients 333‑076‑0165
ASC Medical Records 333‑076‑0170
ASC Quality Assessment and Performance Improvement 333‑076‑0175
ASC Infection Control 333‑076‑0180
In-service Training for ASC Nurses 333‑076‑0185
ASC Physical Environment 333‑076‑0190
ASC Emergency Preparedness 333‑076‑0246
Waivers 333‑076‑0250
ASC Violations 333‑076‑0255
ASC Informal Enforcement 333‑076‑0260
ASC Formal Enforcement 333‑076‑0265
Civil Penalties, Generally 333‑076‑0270
Approval of ASC Accrediting Organizations 333‑076‑0450
Birthing Centers: Definitions 333‑076‑0470
Birthing Centers: Licensing 333‑076‑0490
Birthing Centers: Submission of Plans 333‑076‑0510
Birthing Centers: Expiration and Renewal of License 333‑076‑0530
Birthing Centers: Denial or Revocation of a License 333‑076‑0550
Birthing Centers: Return of Facility License 333‑076‑0560
Birthing Centers: Classification 333‑076‑0570
Birthing Centers: Hearings 333‑076‑0590
Birthing Centers: Adoption by Reference 333‑076‑0610
Birthing Centers: Division Procedures 333‑076‑0630
Birthing Centers: Administration 333‑076‑0650
Birthing Centers: Service Restrictions 333‑076‑0670
Birthing Centers: Policies and Procedures 333‑076‑0690
Birthing Centers: Health and Medical Records 333‑076‑0710
Birthing Centers: Physical Facility 333‑076‑0800
Extended Stay Center (ESC) Applicability 333‑076‑0805
Application for ESC License and Fees 333‑076‑0810
ESC Application Review 333‑076‑0820
Approval of ESC License Application 333‑076‑0830
Denial of ESC License Application 333‑076‑0840
Expiration and Renewal of ESC License 333‑076‑0850
Return of ESC License and ESC Closure 333‑076‑0860
ESC Surveys 333‑076‑0870
ESC Complaints 333‑076‑0880
ESC Investigations 333‑076‑0890
ESC Health Care Practitioner Credentialing 333‑076‑0900
ESC Governing Body 333‑076‑0910
ESC Medical Staff 333‑076‑0920
ESC Personnel 333‑076‑0930
ESC Policies and Procedures 333‑076‑0940
ESC Admission Criteria, Patient Care and Discharge 333‑076‑0950
ESC Patient Transfer 333‑076‑0960
ESC Nursing Services 333‑076‑0970
ESC Pharmacy Services 333‑076‑0980
ESC Laboratory Services 333‑076‑0990
ESC Radiologic Services 333‑076‑1000
ESC Dietary Services 333‑076‑1010
ESC Medical Records 333‑076‑1020
ESC Quality Assessment and Performance Improvement 333‑076‑1030
ESC Infection Control 333‑076‑1040
ESC Data Collection and Reporting 333‑076‑1050
ESC Physical Environment 333‑076‑1065
ESC Waivers 333‑076‑1070
ESC Violations 333‑076‑1080
ESC Informal Enforcement 333‑076‑1090
ESC Formal Enforcement 333‑076‑1100
ESC Civil Penalties
Last Updated

Jun. 8, 2021

Rule 333-076-0117’s source at or​.us