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, and OAR 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. (c) In-home care agencies meeting the requirements in OAR chapter 333, division 536. (4) A self-employed RN who enrolls with the Department to provide long term care community nursing services under these rules must: (a) Pass a background check as defined in OAR 407-007-0200 to 407-007-0370 and OAR 407-007-0600 to 407-007-0640; and (b) Provide and have available verification of all of the following: (A) A current and unencumbered Oregon Registered RN license. (B) Certification of professional liability insurance and commercial general liability insurance with coverage that meets Department requirements. (C) Documentation supporting qualifications and expertise: (i) A minimum of two years full time or equivalent verifiable experience practicing as an RN in an in-home, home health, skilled nursing, hospital, or Department licensed community setting. At least one of these two years must have occurred within three years of the date the RN enrolls with the Department; and (ii) One year experience with providing RN delegation service in the last two years or (iii) A pass score on the Department's test on OSBN’s OAR chapter 851, divisions 006, 045, and 047 to demonstrate satisfactory experience and the skills necessary to perform the duties as described under these rules. (D) Contact information for people or entities that verify the qualifications and expertise documented pursuant to this section. (5) Agencies listed in section (3)(b) and (c) of this rule who enroll with the Department to provide long term care community nursing services under these rules must: (a) Have a current and unencumbered Oregon license pursuant to OAR chapter 333, division 027 or OAR chapter 333, division 536 and maintain compliance with existing in home or home health agency licensing rules; (b) Provide and have available verification of all of the following: (A) Policies and procedures for the in home or home health agency to credential RNs before hiring or contracting and recredential RNs at least every three years to ensure each RN has and maintains a current and unencumbered Oregon RN license at all times. The agency must maintain records of all credentialing and recredentialing activities. (B) Certification of professional liability insurance and commercial general 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 with the RN delegation process in the community-based setting; (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 407-007-0200 to 407-007-0370 and OAR 407-007-0600 to 407-007-0640. (D) Evidence of policies and procedures ensuring that the agency and its employees follow the specific standards in OAR chapter 411, division 048 and OAR chapter 410, division 120 (as applicable) that may exceed OAR chapter 333, divisions 027 or 536.