OAR 309-015-0052: Provider Sanctions

(1) Basis for sanctioning. The Division will follow the Division of Medical Assistance Program rules OAR 410-120-0000 through 410-120-1980 and Section 1902 of the Social Security Act for provider sanctions. The basis for sanctioning will include: (a) Criminal convictions; (b) Exclusion, by the Secretary of Health and Human Services, from participation in the Medicare program; (c) Not meeting the federal regulatory requirements for services in an institution for mental diseases or a psychiatric hospital as set forth at 42 CFR 435.1009 and 42 CFR 441, Subparts C and D; (d) Having deficiencies which immediately jeopardize, or may jeopardize, the health and safety of patients; (e) Abuse and misutilization, as described in OAR 410-120-0000 through 410-120-1980; (f) Termination: (A) From another governmental health/medical program; (B) For failure to repay identified overpayments; or (C) Due to commission, by a provider formerly suspended by the Division, of additional abuse or misutilization. (2) Sanctions. The following sanctions may be imposed on a provider by the Division, based on grounds specified in this rule and may include: (a) Termination from participation in Oregon’s Medical Assistance Program and possible initiation of appropriate civil or criminal proceedings; (b) Suspension from participation in Oregon’s Medicaid Assistance Program; (c) Suspension or withholding of payments to a provider; (d) Required attendance at provider education sessions. (3) Notice to providers. The Division will notify a deficient provider of action the Division plans to take at least 15 days prior to commencement of the action; the notification will include an explanation of the provider’s right to appeal the proposed action (see OAR 309-015-0055).