OAR 411-375-0070: Inactivation and Termination of Independent Providers

(1) An independent provider is not paid for work performed while their provider number is inactivated, inactivated in an emergency, or terminated. (2) STANDARD INACTIVATION. The Department may inactivate a provider number for an independent provider for any of the following reasons until the independent provider takes action to reinstate their provider enrollment: (a) The independent provider informs the case management entity the independent provider is no longer providing services in Oregon. (b) For a personal support worker, the personal support worker fails to participate in a required orientation for personal support workers as described in the Collective Bargaining Agreement. (c) The background check for an independent provider results in a closed case pursuant to OAR 407-007-0320. (d) More than two years have passed since the date on the most recent background check final fitness determination for an independent provider. (e) More than two years have passed since the signature date on the most recent Provider Enrollment Application and Agreement for an independent provider. (f) The independent provider fails to participate in training required by the Department. (g) The independent provider does not request a hearing within 10 business days of a notice of proposed termination. (h) For a personal support worker, the personal support worker has not provided any paid services to any individual in the last 18 months. (3) EMERGENCY INACTIVATION. The Department may immediately inactivate the provider number for an independent provider for any of the following reasons: (a) The independent provider, whether or not providing any paid services to an individual, is being investigated for any alleged violation of the protective service and abuse rules for suspected abuse that poses imminent danger to current or future individuals. (b) The independent provider, whether or not providing any paid services to an individual, is being investigated by law enforcement for a crime listed in ORS 443.004. (c) The independent provider has a credible allegation of fraud according to 42 CFR 455.23. (d) The independent provider knowingly engages in activities that may result in exposure of an individual to the Coronavirus (COVID-19). (A) Activities include: (i) For an independent provider residing with an individual, failure to take reasonable measures to prevent transmittal of COVID-19 as directed by a health care provider or the Local Public Health Authority. (ii) For an independent provider not residing with an individual, having in-person contact with the individual while: (I) Diagnosed with COVID-19 or presumed to have COVID-19 as directed by a health care provider or the Local Public Health Authority; (II) Advised to self-quarantine; (III) Subject to a quarantine or isolation order; or (IV) Symptomatic as described in subsection (B)(ii) of this section. (B) The provider number may be immediately inactivated in the following circumstances: (i) Activities resume sooner than 14 calendar days after an independent provider has been: (I) Diagnosed with COVD-19 or presumed to have COVID-19 as directed by a health care provider or the Local Public Health Authority; (II) Advised by a health care provider to self-quarantine; or (III) Subject to a quarantine or isolation order by a health care provider or the Local Public Health Authority. (ii) Activities resume sooner than 72 hours after an independent provider is symptomatic. Symptoms include, but are not limited to, the following: (I) Fever or chills. (II) Cough. (III) Shortness of breath or difficulty breathing. (IV) Fatigue. (V) Muscle or body aches. (VI) Headache. (VII) New loss of taste or smell. (VIII) Sore throat. (IX) Congestion or runny nose. (4) EMERGENCY INACTIVATION ORDER. The Department shall issue a written order of emergency inactivation of a provider number to the independent provider when the emergency inactivation is based on section (3) of this rule. (a) The Department-issued emergency inactivation order must include the following: (A) Findings of the specific act or omission of the independent provider that violates applicable laws or rules and is the grounds for emergency inactivation. (B) The reasons the specified act or omission presents imminent danger to individuals. (C) A reference to the law or rule involved, including specific sections and subsections. (D) The hearing rights as described in OAR 411-375-0080, including the right to legal representation, if applicable, where to file a hearing request, and the right of the independent provider to request that a hearing be held as soon as practicable to contest the emergency inactivation order. The request for a hearing must be received by the Department within 90 calendar days of the date of the emergency inactivation order or the independent provider shall waive the right to a hearing regarding the emergency inactivation order. (E) The effective date of the emergency inactivation. (b) Service of the emergency inactivation order must be accomplished either by personal service, or service by registered or certified mail. (5) TERMINATION. The Department may terminate the provider number for an independent provider for any of the following reasons: (a) The independent provider violates the requirement to maintain a drug-free work place by either of the following: (A) Being intoxicated by alcohol, inhalants, prescription drugs, or other drugs, including over-the-counter medications, while responsible for the care of an individual, while in the home of the individual, or while transporting the individual; or (B) Manufacturing, possessing, selling, offering to sell, trading, or using illegal drugs while providing authorized services to an individual or while in the home of the individual. (b) The independent provider has an unacceptable background check and the background check results in a closed case pursuant to OAR 407-007-0320. (c) The independent provider demonstrates a lack of skills, knowledge, or ability to adequately or safely provide services as defined in OAR 411-375-0010. (d) The independent provider has a violation of the protective service and abuse rules as defined in OAR 411-375-0010. (e) Notwithstanding abuse as defined in OAR 411-317-0000, OAR 419-100-0010, OAR 411-020-0002, or child abuse as defined in OAR 413-015-0115, the independent provider fails to safely and adequately provide authorized services. (f) The independent provider commits fiscal improprieties including, but not limited to, billing excessive or fraudulent charges or has a conviction for fraud according to 42 CFR 455.23. (g) The independent provider fails to provide services to an individual as described in the individual's Service Agreement or ISP. (h) The independent provider lacks the ability or willingness to maintain individual confidentiality. (i) The independent provider engages in repeated unacceptable conduct at work, such as the following: (A) Delay in arriving to work or absences from work not scheduled in advance with the individual, or as applicable their legal or designated representative, that are either unsatisfactory to the individual, or as applicable their legal or designated representative, or that neglect the service needs of the individual; or (B) Inviting unwelcome guests or pets into the home or community with the individual resulting in the dissatisfaction of the individual, or as applicable their legal or designated representative, or inattention to the service needs of the individual. (j) The independent provider has been excluded or debarred by the Office of the Inspector General. (k) The independent provider fails to perform the applicable duties as a mandatory reporter as required by any of the following: (A) ORS 419B.010 and 419B.015 for abuse of a child. (B) ORS 124.060 and 124.065 for abuse of an older adult 65 years of age or older. (C) ORS 430.737 and 430.743 for abuse of an adult with an intellectual or developmental disability or mental illness. (D) ORS 441.640 and 441.645 for abuse of a resident of a long-term care facility as defined in ORS 442.015. (l) The independent provider fails to provide a Taxpayer Identification Number or Social Security number that matches the legal name of the independent provider as verified by the Internal Revenue Service or Social Security Administration. (m) The independent provider fails to complete training required by the Department as a condition of retaining their provider number due to a violation of these rules. (n) The independent provider has been suspended or terminated as a provider by another division within the Department or by the Oregon Health Authority. (o) Notwithstanding abuse as defined in OAR 411-317-0000, OAR 419-100-0010, OAR 411-020-0002, or child abuse as defined in OAR 413-015-0115, the independent provider either: (A) Uses a safeguarding intervention or safeguarding equipment as a restraint without training in an ODDS-approved behavior intervention system. (B) Uses a safeguarding intervention or safeguarding equipment as a restraint not meeting the standards in OAR 411-375-0035. (p) After April 1, 2020, the personal support worker repeatedly fails to utilize the Electronic Visit Verification interface for eXPRS to record hours worked without an approved exception. (q) The independent provider knowingly engages in activities that may result in exposure of an individual to the Coronavirus (COVID-19). (A) Activities include: (i) For an independent provider residing with an individual, failure to take reasonable measures to prevent transmittal of COVID-19 as directed by a health care provider or the Local Public Health Authority. (ii) For an independent provider not residing with an individual, having in-person contact with the individual while: (I) Diagnosed with COVID-19 or presumed to have COVID-19 as directed by a health care provider or the Local Public Health Authority; (II) Advised to self-quarantine; (III) Subject to a quarantine or isolation order; or (IV) Symptomatic as described in subsection (B)(ii) of this section. (B) The provider number may be terminated in the following circumstances: (i) Activities resume sooner than 14 calendar days after an independent provider has been: (I) Diagnosed with COVD-19 or presumed to have COVID-19 as directed by a health care provider or the Local Public Health Authority; (II) Advised by a health care provider to self-quarantine; or (III) Subject to a quarantine or isolation order by a health care provider or the Local Public Health Authority. (ii) Activities resume sooner than 72 hours after an independent provider is symptomatic. Symptoms include, but are not limited to, the following: (I) Fever or chills. (II) Cough. (III) Shortness of breath or difficulty breathing. (IV) Fatigue. (V) Muscle or body aches. (VI) Headache. (VII) New loss of taste or smell. (VIII) Sore throat. (IX) Congestion or runny nose. (r) The personal support worker works hours in excess of those permitted by OAR 411-375-0040(5)(d) unless the personal support worker: (A) Must exceed the limits imposed by OAR 411-375-0040(5)(d) to ensure the health and safety of an individual during an emergency or urgent situation; and (B) Immediately notifies the individual’s case manager. In the case of an emergency that occurs after local office hours, the personal support worker must notify the case manager within two business days. (6) NOTIFICATION OF PROPOSED TERMINATION. The Department must issue a written notice of the proposed termination of a provider number to the independent provider when the termination is based on section (5) of this rule. (a) For terminations based on a violation of the protective service and abuse rules, the written notice of termination may only contain the information allowed by law. In accordance with ORS 430.753, 430.763, and OAR 411-020-0030, the name of a complainant, witness, or alleged victim, and protected health information may not be disclosed. (b) The Department-issued written notice of the proposed termination must include the following: (A) Findings of the specific act or omission of the independent provider that violates applicable laws or rules and is the grounds for termination. (B) A reference to the law or rule involved, including specific sections and subsections. (C) The hearing rights, if any, of the independent provider as described in OAR 411-375-0080, including the right to legal representation, if applicable, and where to file a request for hearing. (D) The effective date of the termination. (c) Service of the notification of proposed termination must be accomplished either by personal service, or service by registered or certified mail. (7) RETENTION OF PROVIDER NUMBER PENDING TERMINATION HEARING OUTCOME. (a) Unless an independent provider is immediately inactivated as described in section (3) of this rule, the provider number of an independent provider may not be inactivated during the first 10 business days after a notice of proposed termination to provide the opportunity for the independent provider to file a request for hearing. (A) The independent provider must file a request for hearing within 10 business days from the date of the notice of proposed termination if the independent provider wishes to continue to work during the hearing process as described in OAR 411-375-0080. (B) If the independent provider files a written request for a hearing prior to the deadline, the provider number of the independent provider may not be terminated until the hearing process is concluded. (b) EXCLUSIONS. An independent provider may be terminated immediately by the Department for any of the following reasons and the independent provider may not continue to work during the hearing process as described in OAR 411-375-0080 when termination is based on the following: (A) A background check. The independent provider has the right to a hearing in accordance with OAR 407-007-0200 to 407-007-0370. (B) Being excluded or debarred by the Office of the Inspector General. (C) A conviction for fraud according to 42 CFR 455.23. (D) An alleged violation listed in section (5) of this rule and the alleged violation presents imminent danger to current or future individuals. (8) TERMINATION IF NO HEARING REQUEST FILED. (a) An independent provider must file a request for hearing as described in OAR 411-375-0080 within 30 calendar days from the date of the notice of proposed termination. (b) The decision of the Department becomes final if an independent provider does not request a hearing within 30 calendar days from the date of the notice of proposed termination. (c) The Department shall issue a final order by default to the independent provider in accordance with OAR 137-003-0670. The provider enrollment for the independent provider is terminated once the time period for the independent provider to request a hearing has expired.