204 Refusal to Designate, Suspension of Designation, or Withdrawal of Designation of an Individual as a Long-Term Care OR

Policy

The SLTCO has the sole authority, to refuse to designate, suspend designation, or de-designate an individual as an OR.

Procedures

204.1 Criteria for refusal to designate, suspension of designation, or withdrawal of designation of an individual as an OR

The SLTCO has the sole authority to refuse to designate, suspend designation, or de-designate an individual as an OR for any of the following reasons:

  1. Failure of the individual to meet and/or maintain the criteria for designation (II-203.1).

  2. Existence of an unresolved conflict of interest.

  3. Deliberate failure of the individual to disclose any conflict of interest.

  4. Violation of confidentiality requirements.

  5. Failure to provide adequate and appropriate services to long-term care residents.

  6. Failure to timely document cases (including completing journal entries), activities, and other required documentation.

  7. Falsifying records.

  8. Failure to adhere to the Ombudsman Code of Ethics (Appendix A).

  9. Failure to follow LTCO policies and procedures or the direction of the SLTCO.

  10. A change in employment duties which are incompatible with OR duties.

  11. Separation from the LTCOP. Examples include: removal from employment by the designated LE, an extended absence of the OR preventing fulfillment of job responsibilities, provider agency’s contract for the provision of OR services is not renewed.

  12. Failure to act in accordance with applicable federal and state laws, regulations, and policies and/or the SLTCO Policies and Procedures.

204.2 Process for refusal to designate, suspension of designation, or withdrawal of an individual as an Ombudsman Representative

  1. Prior to refusing to designate, suspending designation, or de-designating an individual as an OR, the SLTCO has discretion to, but is not required to, consult with the relevant LE to consider remedial actions which could be taken to avoid the refusal to designate or the de-designation. The SLTCO will take into consideration whether the LE has a history of participating successfully in remedial actions. The SLTCO may also consider the status of the LE; if the contract for services with the LE is ending, then consulting with the LE is unnecessary.

  2. The SLTCO has discretion to determine whether investigation is necessary or whether the documentation or other evidence is sufficient to sustain the de-designation action.

  3. The SLTCO shall provide written notice of the decision to refuse to designate, suspend designation, or de-designate an individual as an OR to the individual who is a candidate for designation, or is currently designated as an OR. The SLTCO has discretion, but is not required, to notify the LE, the AAA, and the Director of the State agency. When such notice is determined to be appropriate, such notice shall:

    1. Specify the reasons for and effective date of the decision.

    2. In the case of a suspension, indicate the circumstances under which the suspension will end or be reconsidered.

  4. The ORC for the service area shall promptly notify the administration of facilities which had been regularly visited by such individual of the refusal to designate, suspension of designation, or de-designation.

  5. If the decision to refuse to designate, suspend designation, or de-designate an individual as an OR results in the absence of OR services in the relevant service area, the LE and the SLTCO shall arrange for the provision of OR services until an OR is designated.

References

OAA § 712(a)(5)