OAR 410-172-0820: Temporary rule language in effect until 02/15/2027. Personal Care Attendant Eligibility, Sanctions and Termination

(1) A personal care attendant (PCA) must meet qualifications in OAR Chapter 418, Division 020, including being at least 18 years of age, and must not be: (a) The individual’s spouse; (b) The parent or legal representative of a minor individual; or (c) The authorized representative or legal representative of an individual. (2) A person can submit an application to become a PCA to the Authority’s IQA and complete required training as described in OAR chapter 418, division 020. (3) The Authority may deny, suspend, or terminate a PCA’s s provider enrollment or re-enrollment and their assigned provider number or impose another sanction on the PCA, as described in OAR chapter 410 division 120. (4) In addition to the Authority’s rights under section (5) below of this rule and OAR chapter 410, division 120, the Authority has the right to immediately suspend a PCA’s provider enrollment and assigned billing number when the Authority has reasonable cause to believe there is an imminent danger or risk of imminent danger to an individual’s life, physical, emotional, or financial well-being. (5) If the Authority determines if it’s necessary to immediately suspend a PCA’s provider enrollment and assigned billing number: (a) The Authority will issue to the PCA a notice that the PCA’s provider enrollment is immediately suspended in accordance with 410-120-1460(5); and (b) The PCA may appeal the immediate suspension as outlined in OAR 410-120-1460(7) and 410-120-1560 through 410-120-1600; and (c) The immediate suspension may remain in effect during any appeal as outlined in 410-120-1460(4). (6) In addition to exercising its right to immediately suspend a PCA’s provider enrollment and assigned provider number as outlined in section (2) this rule, the Authority may also deny, suspend, or terminate a PCA’s provider enrollment and assigned provider number or impose another sanction when the PCA: (a) Has been appointed the authorized representative or legal representative of an individual, is the individual’s spouse, or is the parent or legal representative of a minor individual; (b) Fails to obtain a background check in accordance with OAR chapter 943, division 007, as required in writing by the Authority or has a background check that results in an adverse fitness determination; (c) Lacks the skills, knowledge, or ability to perform the required work as described in these rules and OAR chapter 418, division 020; (d) Forged or otherwise falsified one or more credentials, education or training documentation, or other records submitted to the Authority to obtain approval as a PCA ; (e) Violates the protective service and abuse rules described in OAR Chapter 413, division 15, OAR chapter 411, division 20, or OAR chapter 419, division 110; (f) Commits one or more Fiscal Improprieties as defined in OAR 410-172-0776; (g) Fails to provide the authorized personal care services; (h) Coerces or colludes with the individual to sign or approve false, blank or inaccurate time entries or documents false or inaccurate information in the EVV system; (i) Fails to arrive and depart work at a date and time documented in the work schedule authorized by the individual; (j) Fails to maintain a drug-free workplace which requires: (A) Refraining from manufacturing, possessing, selling, offering to sell, trading, or using illegal drugs while providing personal care services to an individual; and (B) Not being under the influence of substances that inhibit a PCA’s ability to provide personal care services when responsible for the care of an individual. Substances that inhibit a PCA’s ability to perform personal care services include without limitation, any one or more of the following: (i) Alcohol, inhalants, marijuana, marijuana edibles, marijuana tinctures; and (ii) Illicit drugs, legal drugs, and other drugs including prescription drugs, over-the-counter medications, or other similar substances that may inhibit a PCA’s ability to provide personal care services, while responsible for the care of an individual. (k) Has been or is currently excluded as a provider by the U.S. Department of Health and Human Services, Office of Inspector General from participation in Medicaid, Medicare, or any other state or federal health care programs; (l) Has been sanctioned or convicted of a felony or misdemeanor related to a crime, or violation of Title XVIII, XIX, or XX of the Social Security Act, or related state laws; (m) Fails to maintain confidentiality, security and privacy of protected health information, as required by HIPAA and State privacy laws; (n) Exerts undue influence, including coercion, over an individual or their authorized representative; (o) Introduces or creates an unwelcome nuisance to the workplace as determined by the individual; (p) Fails to perform the duties of a mandatory reporter defined in ORS 419B.010 and ORS 430.765; (q) Fails to inform the Authority and their consumer-employer within 14 days of being arrested, cited for, or convicted of any potentially disqualifying crime listed in OAR 125-007-0270; (r) Fails to meet one or more of the mandatory training and competency evaluation requirements described in OAR 418-020-0035; (s) Is an employee of the Oregon Health Authority’s Medicaid or Behavioral Health Divisions, OHA’s Independent and Qualified Agent, the Oregon Department of Human Services (ODHS), the Oregon Home Care Commission (OHCC), or any other entity with the ability to assess for or authorize personal care services for the State Plan Personal Care (SPPC) program; (t) Fails to adhere to the hourly cap described in the CBA or to the service limitations in the service authorization or service plan; (u) Knowingly engages in activities that may pose risks to the health and safety of an eligible individual, or others in the community, including exposure to an infectious disease; (v) Engages in discrimination of others based on race, national origin, color, sex, gender identity, sexual orientation, age, religion, physical, intellectual, developmental, or mental disability, military status, or marital or family status and as described in OAR 410-120-1380(1)(c)(A); (w) Offers or provides services that are not authorized, including using authorized service time for non-covered services, or charging an individual for services outside the service plan; or (x) Knowingly submits or causes to be submitted information or documents that contain inaccurate, misleading, or omitted information and such inaccurate, misleading, or omitted information would result, or has resulted, in an overpayment. (7) The Authority may suspend a PCA and PCA payments in the event it has determined there is suspected fraud or abuse or a credible allegation of fraud as described in OAR 410-120-1510. (8) If the Authority intends to suspend or terminate a PCA’s provider enrollment and assigned provider number or impose one or more other sanctions under sections (4) or (5) of this rule and that misconduct does not pose an imminent risk to the individual: (a) The Authority will notify the PCA via certified mail, personal delivery, or other traceable delivery services, such as email, as outlined in OAR 410-120-1460(5)-(6); and (b) The PCA may appeal the suspension, termination, or sanction as outlined in OAR 410-120-1460 (7) and 410-120-1560 through 410-120-1600 so long as the appeal is not prohibited under section (6) of this rule. (9) The Authority also has the right to take other actions as set forth in OAR 410-120-1460(8). (10) The following situations are excluded from the provider appeal process described in this rule: (a) Terminations or renewal denials based on a background check required prior to enrollment and every two years while enrolled. A PCA who receives a denial notice from the background check unit has the right to a hearing in accordance with OAR 407-007-0200 to 407-007-0370. PCAs will not receive a separate notice from the Authority when terminations or denials are issued as a result of a background check; (b) Termination due to inactivity or no proof of participation for a period of 18 months or more; (c) Denial of provider enrollment or reenrollment based on an applicant’s or a PCA’s failure to provide required and accurate information or information requested by the Authority for a provider enrollment number within the time limits identified in Authority’s letter with initial application or revalidation of the provider enrollment.