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

Universal Citation: OR Admin Rules 409-055-0060

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:

(a) Review of documents and records.

(b) Review of patient medical records.

(c) Review of electronic medical record systems, electronic health record systems, and practice management systems.

(d) Review of data reports from electronic systems or other patient registry and tracking systems.

(e) Interviews with practice management, clinical and administrative staff.

(f) On-site observation of practice staff.

(g) On-site observation of patient environment and physical environment.

(5) Following a verification review, Authority staff may conduct an exit conference with the PCPCH representatives. During the exit conference Authority staff shall:

(a) Inform the PCPCH representative of the preliminary findings of the review; and

(b) Give the PCPCH a reasonable opportunity to submit additional facts or other information to the Authority staff in response to those findings.

(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

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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