OAR 411-048-0220
Medicaid Provider Disenrollment /Termination

(1)

Enrolled Medicaid providers of long term care community nursing services, or RN employees of an agency enrolled as a Medicaid provider providing these long term care community nursing services may be denied enrollment, terminated, or prohibited from providing long term care community nursing services for any of the following:

(a)

Violation of any part of these rules;

(b)

Violation of the protective service and abuse rules in OAR chapter 411, division 020 and chapter 407, division 045;

(c)

Any sanction or action as a result of an OSBN investigation;

(d)

Failure to keep required licensure or certifications current;

(e)

Failure to provide copies of the records described in these rules to designated Department or Oregon Health Authority entities;

(f)

Repeated failure to participate in Nursing Service Plan review or care coordination meetings when requested by an individual’s case manager;

(g)

Failure to obtain a pass score on the Department’s delegation self study test if requested by the Department;

(h)

Failure to provide services;

(i)

Fraud or misrepresentation in the provision of long term care community nursing services;

(j)

Evidence of conduct derogatory to the standards of nursing as described in OAR 851-045-0070 (Conduct Derogatory to the Standards of Nursing Defined) that results in referral to OSBN; or

(k)

A demonstrated pattern of repeated unsubstantiated complaints of neglect or abuse per OAR chapter 411, division 020 and chapter 407, division 045.

(2)

Enrolled Medicaid providers may appeal a termination of their Medicaid provider number based on OAR 407-120-0360 (Consequences of Non-Compliance and Provider Sanctions)(8)(g) and chapter 410, division 120 as applicable.

(3)

Enrolled Medicaid providers of long term care community nursing services must provide advance written notice to the Department at least 30 days prior to no longer providing long term care community nursing services.

(4)

An RN ending long term care community nursing services must comply with the OSBN’s standards regarding transition of care and transfer or rescinding of delegations per OAR chapter 851, division 47.

Source: Rule 411-048-0220 — Medicaid Provider Disenrollment /Termination, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=411-048-0220.

Last Updated

Jun. 8, 2021

Rule 411-048-0220’s source at or​.us