Oregon Administrative Rules
Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS
Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM
Section 409-055-0030 - Practice Application and Recognition Process

Universal Citation: OR Admin Rules 409-055-0030

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

(1) Practices, or other entities on behalf of the practice, that wish to be recognized as a PCPCH shall submit a PCPCH Recognition Application electronically to the Authority via the Program's online application system found on the Program website or by mail to the address posted on the Program website. The application shall include the quantitative data described in OAR 409-055-0040.

(2) The Authority shall review the application within 60 days of its submission to determine whether it is accurate, complete, and meets the recognition requirements. If the application is incomplete the Authority shall notify the applicant in writing of the information that is missing and when it must be submitted.

(3) The Authority shall review a complete application within 60 days of submission. If the Authority determines that the applicant has met the requirements of these rules the Authority shall:

(a) Inform the applicant in writing that the application has been approved as a recognized PCPCH;

(b) Assign a Tier level; and

(c) Include the effective recognition date.

(4) The Authority shall maintain instructions and criteria for submitting a PCPCH Recognition Application posted on the Program website.

(5) The Authority may deny PCPCH recognition if an applicant does not meet the requirements of these rules.

(6) A practice may request that the Authority reconsider the denial of PCPCH recognition or reconsider the assigned tier level. A request for reconsideration must be submitted in writing to the Authority within 90 days of the date of the denial or approval letter and must include a detailed explanation of why the practice believes the Authority's decision is in error along with any supporting documentation. The Authority shall inform the practice in writing whether it has reconsidered its decision.

(7) Recognition shall expire two years from the recognition effective date issued by the Authority.

(a) At the Authority's discretion a 30-day grace period may be allowed for PCPCHs to submit a renewal application without having a lapse in recognition status.

(b) If a PCPCH believes that it meets the criteria to be recognized at a higher tier or increase its point threshold by at least 15 points, it may request to have its tier status reassessed by re-submitting an application not more than once every six months. The Authority may grant exceptions to the six-month time period for good cause shown.

(c) Practices that apply or re-apply for PCPCH recognition between January 2024 and December 2024 will be recognized for one year.

Statutory/Other Authority: ORS 413.042, 413.259, 414.655

Statutes/Other Implemented: ORS 413.259, 413.260, 414.655

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