OAR 411-048-0210
Qualifications for Enrolled Medicaid Providers
(1)
The Department may determine the number and type of enrolled Medicaid providers in a geographic area to assure that there is an appropriate number of qualified enrolled Medicaid providers to meet the needs of individuals eligible for long term care community nursing services.(2)
The Department shall select qualified enrolled Medicaid providers for long term care community nursing services according to the standards in these rules, OAR 407-120-0320 (Provider Enrollment), and chapter 410, division 120 as applicable.(3)
The long term care community nursing services provided under these rules may be delivered by the following enrolled Medicaid providers:(a)
An RN who is a self-employed provider;(b)
Home health agencies meeting the requirements in OAR chapter 333, division 027; or(c)
In-home care agencies meeting the requirements in OAR chapter 333, division 536.(4)
A self-employed RN who contracts with the Department to provide long term care community nursing services under these rules must:(a)
Pass a background check as defined in OAR 407-007-0210 (Definitions); and(b)
Provide and have available verification of the following:(A)
A current and unencumbered Oregon Registered RN license;(B)
Certification of professional liability insurance with coverage that meets Department requirements;(C)
Documentation supporting qualifications and expertise:(i)
A minimum of three years experience practicing as an RN in an in-home, home health, skilled nursing, hospital, or Department licensed community setting. At least one of these three years must have occurred within three years of the date the RN contracted with the Department to provide long term care community nursing services.(ii)
Experience providing nursing delegation or a pass score on the Department’s nursing delegation self study test.(D)
Contact information for people or entities that verify the qualifications and expertise documented pursuant to this section.(c)
The RN must attend a contract briefing session with the local office management to review contract expectations.(5)
Agencies listed in section (3)(b) and (c) of this rule who contract with the Department to provide long term care community nursing services under these rules must:(a)
Maintain compliance with existing in home or home health agency licensing rules;(b)
Maintain a separate contract with the Department to provide Medicaid funded in home care agency services;(c)
Provide and have available verification of the following:(A)
A current and unencumbered Oregon Registered RN license;(B)
Certification of professional liability insurance with coverage that meets Department requirements;(C)
Documentation verifying the qualification and expertise of the RNs hired by the agency to provide long term care community nursing services including:(i)
Experience providing nursing delegation or a pass score on the Department’s nursing delegation self study test;(ii)
Contact information for people or entities that verify the qualifications and experience documented pursuant to this section; and(iii)
A background check as defined in OAR 407-007-0210 (Definitions).(D)
Evidence of policies and procedures ensuring that the agency and its employees follow the specific standards in OAR chapter 411, division 048 that may exceed OAR chapter 333, division 536.
Source:
Rule 411-048-0210 — Qualifications for Enrolled Medicaid Providers, https://secure.sos.state.or.us/oard/view.action?ruleNumber=411-048-0210.