The Oregon Administrative Rules contain OARs filed through November 15, 2015

 

QUESTIONS ABOUT THE CONTENT OR MEANING OF THIS AGENCY'S RULES?
CLICK HERE TO ACCESS RULES COORDINATOR CONTACT INFORMATION

 



OREGON HEALTH AUTHORITY, HEALTH POLICY AND ANALYTICS




 

 DIVISION 45

HEALTH CARE PRACTITIONER CREDENTIALING
409-045-0025
Definitions
The following definitions apply to OAR
409-045-0025 to 409-045-0135:
(1) “Accreditation”
means a comprehensive evaluation process in which a health care organization’s
systems, processes and performance are examined by an impartial external organization
(accrediting entity) to ensure that it is conducting business in a manner that meets
predetermined criteria and is consistent with national standards.
(2) “Advisory Group”
means the Common Credentialing Advisory Group.
(3) “Authority”
means the Oregon Health Authority.
(4) “Board” means
a health care regulatory board or other agency that authorizes individuals to practice
a profession in Oregon related to providing health care services for which the individual
must be credentialed.
(5) “Credentialing”
means a standardized process of inquiry undertaken to validate specific information
that confirms a health care practitioner’s identity, background, education,
competency and qualifications related to a specific set of established standards
or criteria.
(6) “Credentialing
information” means information necessary to credential or recredential a health
care practitioner.
(7) “Credentialing
organization” means a hospital or other health care facility, physician organization
or other health care provider organization, coordinated care organization, business
organization, insurer or other organization that credentials health care practitioners.
This includes, but is not limited to the following:
(a) Ambulatory Surgical Centers.
(b) Coordinated Care Organizations.
(c) Dental Plan Issuers.
(d) Health Plan Issuers.
(e) Hospitals and Health
Systems.
(f) Independent Physician
Associations.
(8) “Delegated credentialing
agreement” means a written agreement between credentialing organizations that
delegates the responsibility to perform specific activities related to the credentialing
and recredentialing of health care practitioners. For telemedicine credentialing,
delegated credentialing agreement has the same meaning given that term in ORS 442.015.
(9) “Distant-site hospital”
means the hospital where a telemedicine provider, at the time the telemedicine provider
is providing telemedicine services, is practicing as an employee or under contract.
(10) “Health care facility”
has the same meaning given that term in ORS 442.015.
(11) “Health care practitioner”
means an individual authorized to practice a profession related to the provision
of health care services in Oregon for which the individual must be credentialed.
This includes, but is not limited to the following:
(a) Acupuncturists.
(b) Audiologists.
(c) Certified Registered
Nurse Anesthetist.
(d) Chiropractor.
(e) Clinical Nurse Specialist.
(f) Doctor of Dental Medicine.
(g) Doctor of Dental Surgery.
(h) Doctor of Medicine.
(i) Doctor of Osteopathy.
(j) Doctor of Podiatric Medicine.
(k) Licensed Clinical Social
Worker.
(l) Licensed Dieticians.
(m) Licensed Marriage and
Family Therapists.
(n) Licensed Massage Therapists.
(o) Licensed Professional
Counselor.
(p) Naturopathic Physician.
(q) Nurse Practitioner.
(r) Occupational Therapists.
(s) Optometrist.
(t) Oral and Maxillofacial
Surgeons.
(u) Psychologists.
(v) Physical Therapists.
(w) Physician Assistants.
(x) Psychologist Associate.
(y) Registered Nurse First
Assistant.
(z) Speech Therapists.
(12) “Health services”
has the same meaning given that term in ORS 442.015.
(13) “Hospital”
has the same meaning given that term in ORS 442.015.
(14) “Originating-site
hospital” means a hospital in which a patient is located while receiving telemedicine
services.
(15) “Primary source
verification” means the verification of an individual practitioner’s
reported qualifications by the original source.
(16) “Program”
means the Oregon Common Credentialing Program.
(17) “Solution”
means the Oregon Common Credentialing Program’s electronic system through
which credentialing information may be submitted to an electronic database and accessed.
(18) “Telemedicine”
means the provision of health services to patients by physicians and health care
practitioners from a distance using electronic communications.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.223, 442.015 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
Credentialing Requirements for
Health Care Practitioners
409-045-0030
Oregon Common Credentialing Program
The Oregon Common Credentialing Program
is established within the Authority for the purpose of providing a credentialing
organization access to information necessary to credential or recredential a health
care practitioner. The Program shall include, but is not limited to the following:
(1) An electronic solution
through which health care practitioner credentialing information must be submitted.
(2) A process by which health
care practitioners or designees may access the Solution to submit information necessary
for credentialing.
(3) A process by which credentialing
organizations may input, access, and retrieve health care practitioner credentialing
information.
(4) A process by which Boards
may input and access health care practitioner credentialing information.
(5) Coordination with Boards
and the process of primary source verification of credentialing information.
Stat. Auth.: ORS 413.042 & 2013
OL Ch. 603
Stats. Implemented: 2013
OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0035
Oregon Practitioner Credentialing
Application
(1) Credentialing organization shall
use the Oregon Practitioner Credentialing Application and the Oregon Practitioner
Recredentialing Application, both approved by the Authority based on recommendations
from the Advisory Committee on Physician Credentialing Information. The Authority
approved applications are available at the on the Committee’s website at http://www.oregon.gov/OHA/OHPR/ACPCI/Pages/index.aspx.
(2) Each credentialing organization
shall use the application forms listed in section (1) of this rule for the purpose
of credentialing and recredentialing health care practitioners.
(3) The Program shall use
the application forms listed in section (1) of this rule as the template for health
care practitioner credentialing information.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0040
Credentialing Information Verifications
(1) The Program shall accept all Board
verifications of credentialing information as provided in accordance with OAR 409-045-0055
and shall supplement those verifications, if necessary, to ensure compliance with
national accrediting entity standards.
(2) Methods for conducting
primary source verification of credentials include direct correspondence, documented
telephone verification, secure electronic verification from the original qualification
source or sources that meet accrediting entity requirements.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0045
Health Care Regulatory Board Participation
(1) A Board that licenses health care
practitioners shall provide practitioner information and documentation to the Solution
in a format and frequency as agreed by the Board and the Authority beginning January
1, 2016. A Board may agree to provide practitioner information and documentation
to the Solution prior to January 1, 2016.
(2) A Board that provides
information to the Solution must also provide an annual attestation to the Authority
that clearly identifies the Boards specific practices related to the process of
primary source verification of health care practitioner information.
(3) Use of practitioner information
provided by Boards shall be authorized through data use agreements that define the
rights to use or disclose the practitioner information and any limitations to that
use.
(4) A Board unable to provide
information to the Solution by January 1, 2016, may submit a petition to the Authority
director for consideration of a waiver from the requirements of section (1). The
Authority shall review the waivers at least every two years for validity. The petition
for a waiver must include:
(a) The name of the Board;
(b) The phone number and
email address for the Board contact person;
(c) A description of specific
barrier to submitting information and documentation;
(d) Efforts or ideas to address
the barrier and the timeframe for doing so; and
(e) The identification of
support, including funding, needed to accomplish the efforts or ideas.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0050
Credentialing Organization Participation
(1) Credentialing organizations shall
obtain health care practitioner credentialing information from the Solution beginning
January 1, 2016, if that information is kept and maintained by the Solution.
(2) Credentialing organizations
may not request credentialing information from a health care practitioner if that
information is available through the Solution. Credentialing organizations may request
additional credentialing information from a health care practitioner for the purpose
of completing credentialing procedures as required by the credentialing organization.
(3) A prepaid group practice
health plan that serves at least 200,000 members in Oregon and that has been issued
a certificate of authority by the Department of Consumer and Business Services may
petition the Authority director to be exempt from the requirements of this section.
The director may award the petition if the director determines that subjecting the
health plan to this section is not cost-effective. If the director grants an exemption,
the exemption also applies to any health care facilities and health care provider
groups associated with the health plan which refers to financial ownership and does
not include services associations. Exemptions may be reviewed by the Authority every
two-years for validity. The petition for exemption must include:
(a) The name of the prepaid
group practice health plan petitioning the Authority and the associated health care
facilities and health care provider groups to be covered under the exemption;
(b) The phone number and
email address for the health plan contact person;
(c) A description of the
prepaid group practice health plan;
(d) A brief description of
the prepaid group practice health plan’s current credentialing practices;
and
(e) A justification of why
the Solution is not cost-effective.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0055
Health Care Practitioner Participation
(1) Health care practitioners required
to be credentialed by a credentialing organization shall submit information and
documentation required pursuant to OAR 409-045-0040 to the Solution beginning on
January 1, 2016 to the extent that information is not available to the Solution
from the Boards. Health care practitioners or their designee may agree to provide
information and documentation required pursuant to 409-045-0040 to the Solution
prior to January 1, 2016.
(2) Health care practitioners
must attest to all credentialing information in the Solution.
(3) Attestation of credentialing
information must occur within 120 days once the complete initial credentialing application
information is submitted. Re-attestation must occur within 120 days from the date
of the initial attestation and every 120 days thereafter. If credentialing information
is updated and attested to by a provider outside of this 120 day re-attestation
cycle, the next required re-attestation shall be due 120 days from the most recent
attestation.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0060
Use of Health Care Practitioner
Information
(1) A credentialing organization that,
in good faith, uses credentialing information provided by the Solution for the purposes
of credentialing health care practitioners is immune from civil liability that might
otherwise be incurred or imposed with respect to the use of that credentialing information.
(2) Health care practitioner
information obtained by Credentialing Organizations through the Solution may only
be used for the intended purpose of credentialing.
(3) All health care practitioner
information that is received, kept, and maintained in the Solution, except for general
information used for directories, is exempt from public disclosure under ORS 192.410
to 192.505.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0065
Common Credentialing Advisory Group
(1) The Authority establishes the Common
Credentialing Advisory Group. Members of the Advisory Group shall be appointed by
the director and shall include members who represent:
(a) Credentialing organizations;
(b) Health care regulatory
boards;
(c) Health care practitioners;
and
(d) The ACPCI.
(2) All members appointed
shall be knowledgeable about national standards relating to health care practitioner
credentialing.
(3) The term of appointment
for each member is three years. If, during a member’s term of appointment,
the member no longer qualifies to serve, the member must resign. If there is a vacancy
for any reason, the director shall appoint a new member which is effective immediately
for the unexpired term.
(4) The Authority and the
Advisory Group shall meet at least once per year.
(5) The Advisory Group shall
advise the Authority on the credentialing process, including but not limited to
the following:
(a) Credentialing industry
standards;
(b) Common Credentialing
Solution;
(c) Recommended changes to
the Oregon practitioner credentialing application pursuant to ORS 442.221 to 441.223;
and
(d) Other proposed changes
or concerns brought forth by interested parties.
(6) Committee members may
not receive compensation or reimbursement of expenses.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0070
Imposition of Fees
Beginning January 1, 2016, the Authority
shall impose fees on credentialing organizations that access the Solution and may
impose fees on health care practitioners who submit credentialing information to
the Solution. Fees may not exceed the cost of administering the Program.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
409-045-0075
Complaints
Complaints regarding the Program and
the Program’s activities shall be submitted to Authority for evaluation through
the Program’s website. The Authority shall provide a response to each complaint
within two weeks of receiving the complaint.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.221 - 441.223 & 2013 OL Ch. 603
Hist.: OHP 3-2014, f. 6-30-14,
cert. ef. 7-1-14
Credentialing Requirements for
Telemedicine Providers
409-045-0115
General Applicability
(1) These rules apply to all:
(a) Telemedicine health care
practitioners who provide telemedicine services from any distant-site hospital in
Oregon to patients in originating-site hospitals in Oregon.
(b) Originating-site hospitals
located in Oregon that credential telemedicine health care practitioners located
at distant-site hospitals in Oregon.
(2) Completion of credentialing
requirements does not require a governing body of a hospital to grant privileges
to a telemedicine health care practitioner and does not affect the responsibilities
of a governing body under ORS 441.055.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.223, 442.015 & 2013 OL Ch. 603
Hist.: OHP 10-2013(Temp),
f. 12-31-13, cert. ef. 1-1-14 thru 6-30-14; OHP 3-2014, f. 6-30-14, cert. ef. 7-1-14
409-045-0120
Standard List of Credentialing Documents
(1) To become credentialed by an originating-site
hospital, a telemedicine healthcare practitioner or the distant-site hospital must
provide the following information and documentation to the originating-site hospital:
(a) A completed current (within
the past 6 months) Oregon Practitioner Credentialing Application (OPCA) and the
following documents:
(A) A copy of state medical
license;
(B) Drug Enforcement Agency
certificate;
(C) State approved foreign
education equivalency certificate or report, if applicable; and
(D) Certification of professional
liability insurance.
(b) Attestation by medical
staff at the distant-site hospital that they have conducted primary source verification
of all materials of the OPCA except for:
(A) Hospital affiliations
other than to the distant-site hospital;
(B) Work history beyond the
previous five years.
(2) Originating-site hospitals
may request documentation of all the verifications above from the distant-site hospital
or the telemedicine health practitioner. Verifications that are not provided may
be obtained separately by the originating-site hospital.
(3) Originating-site hospitals
may not require either the telemedicine healthcare practitioner or the distant-site
hospital to provide the following documentation for the purposes of credentialing
or privileging a telemedicine provider:
(a) Proof of Tuberculosis
Screening;
(b) Proof of vaccination
or immunity to communicable diseases;
(c) HIPAA training verification;
(4) Originating-site hospitals
may not require a telemedicine provider to attend physician and staff meetings at
the originating-site hospital.
(5) Originating-site hospitals
may not request credentialing information if the credentialing information was made
available under OAR 409-045-0120(1) and is not subject to change.
(6) To become recredentialed
by an originating-site hospital, every two years a telemedicine healthcare practitioner
or the distant-site hospital must provide a completed current Oregon Practitioner
Recredentialing Application and all other information required in OAR 409-045-0120(1).
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.223, 442.015 & 2013 OL Ch. 603
Hist.: OHP 10-2013(Temp),
f. 12-31-13, cert. ef. 1-1-14 thru 6-30-14; OHP 3-2014, f. 6-30-14, cert. ef. 7-1-14
409-045-0125
Distant-Site Hospital Agreements
Hospitals may use delegated credentialing
agreements instead of the requirements in OAR-409-045-0120 to stipulate that the
medical staff of the originating-site hospital shall rely upon the credentialing
and privileging decisions of the distant-site hospital in making recommendations
to the governing body of the originating-site hospital as to whether to credential
a telemedicine provider, practicing at the distant-site hospital either as an employee
or under contract, to provide telemedicine services to patients in the originating-site
hospital. If a delegated credentialing agreement is in place the originating-site
hospital is not limited to the information and documents prescribed by the Authority
in OAR 409-045-0120.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.223, 442.015 & 2013 OL Ch. 603
Hist.: OHP 10-2013(Temp),
f. 12-31-13, cert. ef. 1-1-14 thru 6-30-14; OHP 3-2014, f. 6-30-14, cert. ef. 7-1-14
409-045-0130
Hold Harmless Clause
Originating-site hospitals that use
credentialing information provided by distant-site hospitals are immune from civil
liability that might otherwise be incurred or imposed with respect to the use of
that credentialing information.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.223, 442.015 & 2013 OL Ch. 603
Hist.: OHP 10-2013(Temp),
f. 12-31-13, cert. ef. 1-1-14 thru 6-30-14; OHP 3-2014, f. 6-30-14, cert. ef. 7-1-14
409-045-0135
Information Sharing or Use of Data
(1) Telemedicine healthcare practitioners
must provide written, signed permission that explicitly allows the sharing of required
documents and necessary evidence by a distant-site hospital with originating-site
hospitals, including but not limited to any release required under HIPAA or other
applicable laws.
(2) Dissemination of information
received under these rules shall only be made to individuals with a demonstrated
and legitimate need to know the information.
Stat. Auth.: ORS 413.042, 441.056, 441.223
& 2013 OL Ch. 603
Stats. Implemented: ORS 441.056,
441.223, 442.015 & 2013 OL Ch. 603
Hist.: OHP 10-2013(Temp),
f. 12-31-13, cert. ef. 1-1-14 thru 6-30-14; OHP 3-2014, f. 6-30-14, cert. ef. 7-1-14

The official copy of an Oregon Administrative Rule is
contained in the Administrative Order filed at the Archives Division,
800 Summer St. NE, Salem, Oregon 97310. Any discrepancies with the
published version are satisfied in favor of the Administrative Order.
The Oregon Administrative Rules and the Oregon Bulletin are
copyrighted by the Oregon Secretary of State. Terms
and Conditions of Use