Oregon Administrative Rules
Chapter 409 - OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS
Division 55 - PATIENT-CENTERED PRIMARY CARE HOME PROGRAM
Section 409-055-0060 - Verification
Current through Register Vol. 63, No. 9, September 1, 2024
(1) The Authority shall conduct at least one on-site verification review of each recognized PCPCH to determine compliance with PCPCH criteria every five years and at such other times as the Authority deems necessary or at the request of the Health Systems Division (Division), or any other applicable program within the Authority. The purpose of the review is to verify reported attestation and quantitative data elements for the purposes of confirming recognition and Tier level.
(2) PCPCHs selected for a verification review shall be notified no less than 30 days prior to the scheduled review.
(3) PCPCHs shall permit Authority staff access to the practice's place of business during the review.
(4) A verification review may include but is not limited to:
(5) Following a verification review, Authority staff may conduct an exit conference with the PCPCH representatives. During the exit conference Authority staff shall:
(6) Following the review, Authority staff shall prepare and provide the PCPCH specific and timely written notice of the findings.
(7) If the findings result in a referral to the Division pursuant to OAR 409-055-0070, Authority staff shall submit the applicable information to the Division for its review and determination of appropriate action.
(8) If no deficiencies are found during a review, the Authority shall issue written findings to the PCPCH indicating that fact.
(9) If deficiencies are found, the Authority shall take informal or formal enforcement action pursuant to OAR 409-055-0070.
(10) The Authority may share application information and content submitted by practices and verification findings with managed or coordinated care plans, and insurance carriers.
Statutory/Other Authority: ORS 413.042, 413.259 & 414.655
Statutes/Other Implemented: ORS 413.259, 413.260 & 414.655