Or. Admin. Code § 410-136-3280

Current through Register Vol. 63, No. 10, October 1, 2024

Section 410-136-3280 - Client Rights and Confidentiality

(1) Brokerages shall treat all information gathered on the client as privileged and confidential communications. The brokerage shall apply confidentiality policies to all requests for information from outside sources. Nothing prohibits the disclosure of information in summaries, statistical reports or other forms as long as the document does not identify particular individuals and cannot lead to the identification of individuals. Brokerages and any subcontractors may share information as necessary to serve the client effectively. The brokerage shall not divulge the information without the written consent of the client, the responsible parent of a minor child or the client's legal guardian. The use or disclosure of information is limited to persons directly administrating NEMT services.

(2) Brokerages and their subcontractors shall comply with OAR 943-014-0300 through 943-014-0320 pertaining to access control if the Authority grants them access to any secure computer system or information asset.

(3) Brokerages and their subcontractors shall comply with the Authority's non-discrimination and modification rules found at OAR 943-005-0000 to 943-005-0070.

(4) The brokerage shall not deny or allow subcontractors to deny any client NEMT services based on race, color, sex, gender, gender identity, gender presentation, sexual orientation, religion, national origin, creed, marital status, age, health status or the presence of any sensory, mental, intellectual, developmental, IQ score, or physical disability.

(5) Brokerages must treat clients and require subcontractors and all drivers to treat clients in accordance with OAR 410-120-1855, Client Rights and Responsibilities, including but not limited to:

(a) To ensure clients and their representatives have communications and materials explained in their preferred spoken or sign language;

(b) To ensure clients receive written materials describing rights, responsibilities, benefits available, how to access services, and what to do in an emergency.

(6) The brokerages shall have educational materials available for clients on its NEMT services. The Oregon Health Authority (Authority) must first approve the materials and document the approval in writing. Subcontractors shall use Authority approved NEMT education materials.

(7) As required by 42 CFR 431, a brokerage shall follow OAR 410-120-1855 through 410-120-1865 pertaining to contested case hearings when it denies a ride, with the following exceptions:

(a) The brokerage must immediately provide a secondary review by another employee when the initial screener denies a ride; and

(b) The brokerage must mail a notice of action to a client denied a ride within 72 hours of denying a ride explaining why the client's ride has been denied and hearing rights to appeal the denial.

(8) The brokerages shall reinstate a denied service consistent with 42 CFR 431.231 in the following circumstances:

(a) if action is taken without the advance notice required;

(b) if a beneficiary requests a hearing within ten (10) days after the date of action, or if determined action had resulted from other than the application of Federal or State law or policy; or

(c) if a beneficiary's whereabouts become known during a time they are eligible for services.

(9) Brokerages must have and maintain documentation pertaining to all authorization and denial of services. Upon the Authority's request, brokerages shall provide documentation pertaining to discovery for any investigation, or for contested case hearings pursuant to OAR 410-120-1360.

(10) Brokerages shall provide documentation pertaining to discovery for or investigation of contested case hearings when the client, the responsible parent of a minor child or the client's legal guardian requests the documentation. The brokerage shall provide the documentation to the client's legal representative upon written consent from the client, the responsible parent of a minor child or the client's legal guardian.

(11) Brokerages shall have and maintain policies and procedures which shall include, without limitation, policies and procedures that comply with this rule. Brokerages shall provide client rights and responsibilities policy and procedures information from this rule to its NEMT subcontractors and require the NEMT subcontractors to implement and follow such policies and procedures. Brokerages shall include client rights and responsibilities policy and procedures in their member handbooks and posted on their websites. Brokerages must monitor subcontractors' compliance with client rights and responsibilities policies and procedures of this rule.

Or. Admin. Code § 410-136-3280

DMAP 36-2013, f. 6-27-13, cert. ef. 7-1-13; DMAP 95-2023, amend filed 12/22/2023, effective 1/1/2024

Statutory/Other Authority: ORS 413.042

Statutes/Other Implemented: ORS 414.065