Or. Admin. Code § 333-004-3020

Current through Register Vol. 63, No. 11, November 1, 2024

Section 333-004-3020 - Agency Certification and Recertification Process

(1) Agency eligibility. To be eligible to be certified with the RH Program, an applicant agency must:

(a) Meet applicable licensing or regulatory requirements set forth by federal and state statutes, regulations, and rules.

(b) Have a valid business license if such a license is a requirement of federal, state, or local government to operate a business or to provide services.

(c) Have a current CLIA certification, if applicable.

(d) Have a current Board of Pharmacy license, if applicable.

(e) Be enrolled as an OHP Provider.

(f) If an applicant agency is located out of the State of Oregon, it may enroll under the following conditions:

(A) The applicant agency is appropriately licensed or certified and meets standards established within the provider's state for participation in Medicaid; and

(B) The applicant agency is located in a state contiguous to Oregon and is within 75 miles of the Oregon border.

(g) An applicant agency or any of its providers that are currently subject to sanctions by the Authority or the federal government are not eligible for enrollment as an agency.

(2) Pre-Certification meeting. Prior to becoming certified, applicant agencies must meet with RH Program staff to discuss program requirements and clinic staff capacity. Applicant agency/clinic staff that must attend the meeting may include:

(a) Authorizing official(s);

(b) Clinical supervisor(s);

(c) Billing supervisor(s); and

(d) Front desk manager(s).

(3) Application process.

(a) To apply to operate RHCare clinic(s), applicant agencies and their clinic(s) shall:

(A) Complete and submit to the RH Program a Certification Application for RHCare Clinics and all supporting documents for clinics that individually meet the Certification Requirements; and

(B) Respond to all requests or questions from the RH Program during application review.

(b) To apply to operate CCare clinic(s), applicant agencies and their clinic(s) shall:

(A) Complete and submit to the RH Program a Certification Application for CCare Clinics and all supporting documents for clinics that individually meet the Certification Requirements; and

(B) Respond to all requests or questions from the RH Program during application review.

(c) To apply to operate AbortionCare clinic(s), applicant agencies and their clinic(s) shall:

(A) Complete and submit to the RH Program a Certification Application for AbortionCare Clinics and all supporting documents for clinics that individually meet the Certification Requirements; and

(B) Respond to all requests or questions from the RH Program during application review.

(4) Application review process. The RH Program will review the applicant agency's application and supporting documents to determine if the agency and its clinic(s) meet RHCare, CCare, or AbortionCare Certification Requirements.

(5) Application approval.

(a) Upon approval, the applicant agency will sign a MSA. Signing a MSA constitutes an agreement by the agency to comply with all applicable rules of the RH Program, the Health Systems Division, and federal and state laws and regulations.

(b) The RH Program may require an on-site verification review within one year of approval.

(c) The RH Program may grant certification to an agency in whole or in part, by limiting the number of clinics within the first year of certification. To certify additional clinics, agencies will need to complete a new clinic certification request form and amend the agency's MSA.

(d) The RH Program may grant grace periods for implementation of specific requirements.

(6) Application denial. The RH Program may deny an application for certification if it has evidence that the applicant agency or its clinic(s) does not meet all requirements for certification.

(7) Agency recertification. Agencies must apply for recertification every odd numbered year prior to the expiration of certification.

(a) Recertification process. Submit recertification application prescribed by the Authority, and other documentation required in the application.

(b) Recertification approval. Upon approval, agencies will receive a letter notifying them of their approval.

(c) Recertification denial. Upon denial, agencies will receive a letter notifying them of their denial. The RH Program may deny an agency's recertification for reasons including, but not limited to:

(A) Failure to address compliance findings within 180 calendar days of the date of initial non-compliance notification;

(B) No client enrollment or claims activity for 12 months; or

(C) Sanctions detailed in OAR 333-004-3200 (Grounds for Agency Sanctions; Sanctions).

(8) If an agency does not apply for recertification or if recertification is denied, the agency's MSA is terminated.

Or. Admin. Code § 333-004-3020

PH 84-2020, adopt filed 12/18/2020, effective 1/1/2021; PH 186-2022, minor correction filed 09/07/2022, effective 9/7/2022

Statutory/Other Authority: ORS 413.042, ORS 414.432, ORS 431.147, ORS 431.149 & OL 2022, ch. 45, sec. 10

Statutes/Other Implemented: ORS 414.432, ORS 431.147, ORS 413.032 & OL 2022, ch. 45, sec. 10