(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).
Statutory/Other Authority
ORS 413.042
Statutes/Other Implemented
ORS 414.025 & 414.065
History
MHD 2-1994, f. & cert. ef. 2-24-94
MHD 12-1990, f. & cert. ef. 10-15-90
MHD 6-1989, f. & cert. ef. 11-17-89