1. (1) Direct nursing services may be delivered by the following enrolled Medicaid providers:

   1. (a) A self-employed LPN or RN licensed under ORS 678.021 that may also be an adult foster home provider or family member.

      1. (A) An adult foster home provider must also be licensed under OAR 411-360-0040.

      2. (B) The decision to have an adult foster home provider or family member deliver direct nursing services must:

         1. (i) Be made by the individual and the ISP team;
         2. (ii) Be documented; and
         3. (iii) Not be for the convenience of the adult foster home provider or family member.
   2. (b) Home health agency licensed under ORS 443.015 and meeting the requirements in OAR chapter 333, division 027.
   3. (c) In-home care agency licensed under ORS 443.315 and meeting the requirements in OAR chapter 333, division 536.
   4. (d) A direct nursing services agency meeting the requirements in OAR 411-380-0065.
2. (2) The legal representative of an individual is prohibited from providing direct nursing services.

3. (3) A provider of direct nursing services must:

   1. (a) Be a licensed RN or LPN with a current and unencumbered license; and
   2. (b) Meet and maintain the provider enrollment requirements under OAR 407-120-0320 and section (5) of this rule. .
4. (4) At least one year of experience working with individuals with intellectual or developmental disabilities is recommended, but not required.

5. (5) PROVIDER ENROLLMENT.

   1. (a) Providers must enroll through the MMIS system by:

      1. (A) Completing and submitting the Medicaid Provider Enrollment Application that includes the Provider Enrollment Agreement;
      2. (B) Completing a Background Check as described in OAR 407-007-0200 through 407-007-0370. Background check approval is effective for two years from the initial fitness determination; and
      3. (C) Enrolling, receiving, and submitting a National Provider Index Number.
   2. (b) An applicant listed in the exclusions database of the Office of the Inspector General is not eligible to become an enrolled Medicaid provider according to OAR 410-120-1400(3)(b).
6. (6) All enrolled Medicaid providers must comply with federal, state, and Department conflict of interest regulations or policy.

Statutory/Other Authority

ORS 409.050, 413.085 & 427.104

Statutes/Other Implemented

ORS 409.010, 413.085, 427.007 & 427.104

History

APD 16-2021, amend filed 05/26/2021, effective 06/01/2021
APD 1-2020, minor correction filed 02/07/2020, effective 02/07/2020
APD 21-2019, amend filed 06/28/2019, effective 07/01/2019
APD 3-2017, f. 2-21-17, cert. ef. 2-28-17
APD 34-2016(Temp), f. 8-30-16, cert. ef. 9-1-16 thru 2-27-17
APD 14-2016, f. 6-28-16, cert. ef. 6-29-16
APD 28-2015(Temp), f. 12-31-15, cert. ef. 1-1-16 thru 6-28-16