Or. Admin. R. 411-323-0030

Current through Register Vol. 63, No. 6, June 1, 2024

Section 411-323-0030 - Certification and Endorsement Application Process and Standards

(1) Except as described in section (2) of this rule, an application for a certificate and at least one endorsement must be approved by the Department, under these rules, before an agency may deliver program services. An agency may only deliver a program service when the agency has a certificate and an endorsement to the program service's corresponding program rules.

(2) A site licensed or certified under OAR chapter 411, division 054 for residential care and assisted living facilities, OAR chapter 309, division 035 for behavioral health services residential treatment facilities and residential treatment homes, OAR chapter 419, division 400 for child-caring agencies, or OAR chapter 416, division 550 for treatment foster care does not require additional certification as an agency under these rules to deliver 24-hour residential services. Current license or certification is considered sufficient demonstration of ability to:

(a) Recruit, hire, supervise, and train qualified staff;

(b) Deliver services according to an ISP or Service Agreement; and

(c) Develop and implement operating policies and procedures required for managing an agency and delivering services, including provisions for safeguarding individuals receiving services.

(3) CERTIFICATE APPLICATION. Except as described in section (2) of this rule, an applicant intending to deliver program services must apply for a certificate. The material submitted to the Department as part of an application shall be approved if the application and material demonstrates to the satisfaction of the Department that the applicant is in compliance with these rules, the rules in OAR chapter 411, division 004, and the applicant has the skills, knowledge, and ability to operate an agency and does not meet any criteria for denial or revocation of a certificate as described in OAR 411-323-0033(3).

(a) An initial application for a certificate is not accepted if the person identified on the agency application as the executive director of the agency has not successfully completed the orientation described in OAR 411-323-0029. Documentation of the successful completion must be retained by the executive director.

(b) The Department shall begin to evaluate an application when the Department has received a complete application. A complete application for a certificate must include:

(A) A complete and accurate agency application using a form supplied by the Department for this purpose. The application form must be signed and dated by the applicant before the form is considered complete.

(B) A copy of any management agreements or contracts relative to the operation and ownership of the agency.

(C) The agency's policies and procedures required by OAR 411-323-0050 sections (1) and (2) and OAR 411-323-0060. The policy and procedures document must identify where these are located. The policies and procedures must demonstrate to the satisfaction of the Department that the applicant can operate an agency.

(D) A business plan submitted to the Department that includes:

(i) A revenue and expense forecast and a balance sheet which indicate capital and the financial plan developed to assure sustainability, partnerships, loans, and any other financial assistance.

(ii) Evidence of the financial ability to operate the agency and the ability to maintain sufficient liquid resources to pay the operating costs, including labor costs, wages, and benefits, for all programs and at least three months of cash on hand or equivalency.

(iii) A plan identifying the scope of services the applicant intends to provide, including the counties the applicant will operate in and staff recruitment and staff retention strategies.

(iv) The structure of any entity including any business entity with a controlling interest in another company or the entity itself.

(E) As required by 42 CFR 455.104:

(i) The name and address (including primary business address, every business location, and P.O. Box address) of any person who is an applicant.

(ii) The date of birth and social security number for any person who is an applicant.

(iii) In the case of an entity, the tax identification number of the entity with an ownership or control interest in the entity, fiscal agent, or managed care entity or of any subcontractor in which the entity, fiscal agent, or managed care entity has 5 percent or more interest.

(iv) The name of any other agency, fiscal agent, or managed care entity in which an owner of the agency, fiscal agent, or managed care entity has an ownership or control interest.

(v) The name, address, date of birth, and social security number of any managing employee of the agency, fiscal agent, or managed care entity.

(F) For the executive director:

(i) An approved background check.

(ii) Documentation of mandatory abuse training.

(iii) Proof of certification in CPR and First Aid by a recognized training agency if the executive director will provide care to individuals.

(iv) A resume that demonstrates the executive director meets the qualifications listed in OAR 411-323-0050(6).

(v) Documentation of successful completion of the orientation if required by OAR 411-323-0029.

(G) Additional information or documentation required by the Department after an agency submits an application.

(H) Proof of insurance coverage as required by the ODDS Provider Enrollment Agreement.

(I) Partnerships and S-Corporations are required to provide personal tax returns for all owners. Except for an initial application for a certificate, the application must include;

(i) An audit completed in the past year; or

(ii) Previous two years tax returns including all required schedules.

(J) Copies of bank statements from the last three months demonstrating banking activity in both checking and savings accounts, as applicable, or demonstration of cash on hand, if requested.

(K) For an initial application, a description of the organizational history of the applicant for the previous ten years preceding the request for certification.

(4) ENDORSEMENT APPLICATION. Only an applicant who has been approved for a certificate may apply for an endorsement. Separate endorsements are required for an agency to deliver each program service. The material submitted to the Department as part of a complete application shall be approved if the complete application demonstrates to the satisfaction of the Department that the applicant is in compliance with these rules, the rules in OAR chapter 411, division 004, the program rules, and the applicant has the skills, knowledge, and ability to deliver the program service and does not meet any criteria for denial or revocation of a certificate or endorsement as described in OAR 411-323-0033(3).

(a) An application for an endorsement will not be considered for approval by the Department unless the applicant has a current Medicaid certificate.

(b) The Department shall begin to evaluate an application when the Department has received a complete application. A complete application for an endorsement includes all of the following:

(A) A complete and accurate request for endorsement on a form supplied by the Department for this purpose. The endorsement request form must be signed and dated by the applicant before the form is considered complete.

(B) The policies and procedures required by corresponding program rules for all requested endorsements. The policy and procedures document must identify where these are located. The policies and procedures must demonstrate to the satisfaction of the Department that the agency can deliver services consistent with these rules and the corresponding program rules.

(C) For an endorsement to deliver professional behavior services:

(i) Documentation that any behavior professional who will be delivering professional behavior services meets the qualifications identified in OAR 411-304-0170(1) and (2); and

(ii) The information identified in OAR 411-304-0170(4).

(D) For an endorsement to deliver direct nursing services, a resume for each nurse who will be delivering direct nursing services.

(E) For an endorsement to deliver community living supports or employment services that are delivered in a provider owned, controlled, or operated setting, as defined in OAR 411-317-0000:

(i) A copy of the fire, health, and safety inspections;

(ii) A fire inspection report; and

(iii) An insurance inspection report or Oregon Occupational Safety and Health (OSHA) safety inspection report.

(F) All geographic locations where programs are to be operated must be identified on the request form, if required by the program rules.

(G) An agency must make a request to the Department, using a form provided by the Department, to add a geographic location to an existing endorsement when required by the program rules. The request to add a geographic location must include an updated business plan described in section (3)(b)(D) of this rule. The request shall be approved or denied based on the standards established in these rules and the corresponding program rules. The following considerations shall be given for approval of adding geographic locations:

(i) Number of current geographic locations.

(ii) Current status of geographic locations and if current locations are in compliance.

(iii) History of current and previous endorsements and licenses.

(iv) Financial stability of the agency.

(H) To add an additional endorsement for a program service, an agency must apply for the additional endorsement by submitting a request to the Department. The request must include the documentation described in sections (3)(b)(D) and (4)(b)(A)(B)(C)(D)(E) of this rule. The additional endorsement shall be approved or denied based on the standards established in these rules and the corresponding program rules.

(5) CERTIFICATE AND ENDORSEMENT STANDARDS.

(a) Certificates and endorsements are not transferable to another person or organization.

(b) Separate endorsements are required for each program service type operated by a certified agency.

(c) An agency is certified for two years unless the certificate is sooner revoked or suspended.

(d) An agency is endorsed through the end date of its current certificate unless the endorsement is sooner revoked or suspended.

(e) An agency whose certificate was denied, voluntarily surrendered after service with corrective action, or revoked in accordance with OAR 411-323-0033(3), may not reapply for a certificate for three years from the date of the denial or revocation.

(f) An applicant must provide complete, accurate, and truthful information during the application process. An applicant who voluntarily withdraws an application containing willfully incomplete, inaccurate, or untruthful information may not submit an application for a certificate or endorsement for three years from the date of the withdrawal. Withdrawal of an application does not limit or prevent the Department or other state or federal regulators from leveling other penalties or continuing investigations into potential criminal violations or other violations.

(g) An agency applicant must be registered with the Oregon Secretary of State Business Division. The address used to register the business with the Oregon Secretary of State Business Division must be used as the primary address on both the certification and endorsement applications. Department correspondence is only sent to the primary mailing address used on the application.

(h) An applicant is considered responsible for acts occurring during, and relating to, the operation of the agency.

(i) The Department may consider the background, operating, and financial history of an applicant when determining whether to issue a certificate or an endorsement. Sources may include, but are not limited to:

(A) Social and other media.

(B) Records kept by the Oregon Health Authority on enrolled providers and providers requesting enrollment in the Oregon Health Plan.

(C) Abuse investigation history from ODDS, the Office of Aging and People with Disabilities, the Oregon Health Authority, and Child Welfare.

(D) The operating history of any other agency licensed or certified by the Department or Oregon Health Authority or similar bodies in other jurisdictions.

(E) Criminal history.

(F) Federal resources including, but not limited to:

(i) Social Security Administration's Death Master File.

(ii) The National Plan and Provider Enumeration System (NPPES).

(iii) The List of Excluded Individuals/Entities (LEIE), the Office of Inspector General exclusion list under sections 1128 or 1128A of the Social Security Act, or the Medicare Exclusion Database (MED).

(iv) The Excluded Parties List System (EPLS) or the System for Award Management (SAM).

(G) State resources including the Secretary of State and licensing or certification boards.

(j) An application may not be considered for approval if a completed application required by section (3)(b) or (4)(b) of this rule is not made available to the Department within 30 calendar days from the date the Department receives the signed application form as required in this rule unless the Department approves a request to extend the time frame.

(k) An application may not be considered for approval if an applicant does not respond to a request from the Department for information necessary to make a decision whether to approve or deny the application within 30 calendar days of the request.

(l) An application for a certificate or endorsement must be submitted to the Department prior to the expiration date of an agency's certificate. The Department may suspend an applicant's Medicaid Agency Identification Number and Medicaid Performing Provider Number, as described in OAR chapter 411, division 370, upon the expiration date of a certificate.

(m) An agency is considered to meet the requirement for certification and endorsement as required by section (1) of this rule when a complete application for a certificate and endorsement is filed with the Department before the date of expiration of the certificate or endorsement, until the Department issues a Final Order on the application.

(n) A certificate and endorsement expire on the date an agency ceases operation.

(o) A certificate or endorsement that is required to be returned to the Department is expired on the date the action that causes the certificate or endorsement to be returned is taken. A certificate or endorsement is required to be returned to the Department immediately upon:

(A) Suspension or revocation of the certificate or endorsement.

(B) When agency operation is discontinued.

(C) When an agency's Provider Enrollment Agreement is terminated by the Department in accordance with OAR 411-370-0030(14).

(D) When an agency's Medicaid Agency Identification Number or Medicaid Performing Provider Number is terminated.

(6) CHANGE OF EXECUTIVE DIRECTOR, OWNERSHIP, LEGAL ENTITY, LEGAL STATUS, OR MANAGEMENT CORPORATION. An amended certificate and new endorsements are required upon a change of the executive director, ownership, legal entity, legal status, or management corporation of the agency 90 calendar days in advance of the change. If circumstances require more immediate action, the agency must notify the Department immediately.

Or. Admin. R. 411-323-0030

SPD 19-2011(Temp), f. & cert. ef. 7-1-11 thru 12-28-11; SPD 12-2011, f. & cert. ef. 7-1-11; Reverted to SPD 12-2011, f. & cert. ef. 7-1-11; SPD 1-2012, f. & cert. ef. 1-6-12; APD 24-2014(Temp), f. & cert. ef. 7-1-14 thru 12-28-14; APD 42-2014, f. 12-26-14, cert. ef. 12/28/2014; APD 35-2015(Temp), f. 12-31-15, cert. ef. 1-1-16 thru 6-28-16; APD 25-2016, f. & cert. ef. 6/29/2016; APD 21-2019, amend filed 06/28/2019, effective 7/1/2019; APD 44-2019, amend filed 10/29/2019, effective 11/1/2019; APD 16-2023, amend filed 09/30/2023, effective 10/1/2023

Statutory/Other Authority: ORS 409.050, 427.104, 430.662 & SB 1548 (2022 OR Law, Ch. 91)

Statutes/Other Implemented: ORS 409.010, 427.007, 427.104, 430.215, 430.610, 430.662 & SB 1548 (2022 OR Law, Ch. 91)