OAR 411-380-0070: Provider Disenrollment and Termination

(1) Enrolled Medicaid providers may be denied enrollment, terminated, or prohibited from providing direct nursing services for any of the following: (a) Violation of any part of these rules. (b) A founded report of child abuse or substantiation of a violation of the protective service and abuse rules in OAR chapter 411, division 020 or OAR chapter 419, division 100. (c) Any sanction or action as a result of an investigation of the Oregon State Board of Nursing. (d) Failure to keep required licensure or certifications current. (e) Failure to provide copies of the records described in these rules to OHA, the Department, or case management entity. (f) Failure to participate in the review of the Nursing Service Plan or care coordination meetings when requested by the case management entity. (g) Failure to provide services. (h) Fraud or misrepresentation in the provision of direct nursing services. (i) Evidence of conduct derogatory to the standards of nursing as described in OAR 851-045-0070 that results in referral to the Oregon State Board of Nursing. (j) A demonstrated pattern of repeated unsubstantiated complaints of neglect or abuse per OAR chapter 411, division 020 or OAR chapter 419, division 100. (k) The provider is listed in the exclusions database of the Office of the Inspector General. (2) Enrolled Medicaid providers may appeal a termination of their Medicaid provider number based on OAR 407-120-0360(8)(g) and OAR chapter 410, division 120, as applicable. (3) An enrolled Medicaid provider of direct nursing services must provide advance written notice to the Department and any individuals the provider is delivering direct nursing services to at least 30 days prior to no longer providing direct nursing services.