Oregon Administrative Rules
Chapter 309 - OREGON HEALTH AUTHORITY, HEALTH SYSTEMS DIVISION: BEHAVIORAL HEALTH SERVICES
Division 15 - MEDICAID PAYMENT FOR PSYCHIATRIC HOSPITAL INPATIENT SERVICES
Section 309-015-0052 - Provider Sanctions

Universal Citation: OR Admin Rules 309-015-0052

Current through Register Vol. 63, No. 9, September 1, 2024

(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).

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.025 & 414.065

Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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