Samaritan Health Plans works with various types of providers, contractors and first tier, downstream and related entities, also known as FDRs (sometimes referred to as subcontractors or delegated entities). If you are contracted with SHP to provide administrative and/or health care services for our Medicare or Medicaid members/line of business, then you must comply with the contractual training requirements.
Providers, contractors and FDRs have the opportunity to use SHP-created training courses or otherCMS-approved training. Regardless of whether you take the SHP training or take the training from another organization, you will need to attest to completing the following training courses upon hire and annually thereafter.
Who needs to take these training courses?
Review HSAG, CMS, NCQA and/or SHP policies.
When do these training courses need to be taken?
Upon first being hired/contracted with SHP and annually thereafter. Compliance may require refresher training, as needed.
If I have questions about the training courses, who do I contact?
Please contact SHPOCompliance@samhealth.org for any training-related questions or concerns.
Do I have to take the SHP training courses?
Contract staff – Yes. Review the training and complete the attestation form below.
Providers and FDRs – No. SHP’s training courses are designed to review all CMS, HSAG, NCQA and SHP requirements. This is why reviewing the SHP training is preferred; however, several organizations provide these training courses with all requirements in mind. If you do not use the SHP training, please be sure to keep a copy of what the training topics were, when you took them and who provided the training in the case of an audit.
Regardless of whether you take SHP’s training or another organization’s training, you will need to complete the attestation form below (see Attestation).
In this lesson, you will learn about SHP’s Compliance and Program Integrity plan. This training will:
SHP General Compliance Training – Overview
Complete the attestation form found below after reviewing this required training (see Attestation).
In this lesson, you will learn about SHP’s Fraud, Waste, and Abuse program, also known as FWA. This training will:• Introduce the concepts of Medicare and Medicaid FWA.• Review applicable state and federal laws.• Review recent Oregon cases to learn from.
FWA Training for Medicare & Medicaid Programs
In this lesson, you will learn about SHP’s Dual Advantage Plan , Model of Care (SNP-MOC) program. This training has four parts:• Section 1: Description of the SNP general population.• Section 2: Care Coordination.• Section 3: Provider Network.• Section 4: MOC Quality Measurement and Performance Improvement.
Special Needs Model of Care Training
SHP Contract Employees should fill out the attestation form below once all three training courses have been completed.
Providers, subcontractors, and/or delegated entities should fill out this attestation once they have completed all three training courses SHP provides or once they have completed the training provided by a different entity.
Please note, if you do not use SHP’s training, please be sure to keep a copy of what the training topics were, when you took them and who provided the training in case of an audit.
To advance health equity and ensure the delivery of culturally respectful and linguistically responsive health services, the Oregon Legislature mandated cultural competency continuing education for health care professionals starting July 1, 2021. Under the requirement, Oregon health care professionals must complete cultural competency continuing education as a condition of licensure.
Oregon health care professionals whose license is at a practicing status must meet this requirement. The only exceptions are providers in residency training and volunteer camps. Providers with a “retired” status do not have to meet the requirement because their license is not at a practicing status.
Providers must complete an average of at least one hour of cultural competency education per year during an audit period. An audit period is two renewal cycles, for example, every four years for most providers. Required hours will be based on the number of years licensed during the audit period; any portion of a year licensed will require one hour of cultural competency education. For example, a provider who has been licensed for 3.5 years during the audit period will be required to obtain four hours of cultural competency education. Hours may be obtained at any time during the audit period. For example, either one four-hour experience, or four one-hour courses taken annually, would satisfy the requirement.
The cultural competency continuing education may, but does not have to, be accredited continuing medical education (CME). The law was written to allow a wide array of courses or experiences, which may include: courses delivered in-person or electronically, experiential or service learning, cultural or linguistic immersion, volunteering in a rural clinic, completing an employer’s cultural competency training, attending an event with members of an underserved community to discuss health care access issues, or courses approved by the Oregon Health Authority.
In addition to the courses listed by the Oregon Health Authority, the U.S. Department of Health & Human Services offers a free online program that includes up to 9 CME credits. For more information visit Education – Think Cultural Health (hhs.gov).
Providers may track educational hours on an OMB record keeping form. During license renewal (annually or biennially depending on the license), providers will attest to completing the required hours by checking a box and reporting the number of hours obtained. The OMB will audit for compliance every other renewal cycle with the first audit being conducted during the Fall 2023 renewal cycle. The cultural competency audit will be included within the existing audit for CME compliance. Beginning in 2023 and every other renewal cycle thereafter, audited providers will be asked to also produce documentation of their cultural competency educational experiences. Documentation may be a course certificate, the OMB record keeping form, or other documentation.
For more information regarding cultural competency requirements for Oregon providers, please visit Oregon Medical Board page on Oregon.gov.
SHP requires that all providers, contractors and subcontractors/delegated entities comply with training requirements.
SHP contractors must complete SHP provided training (above).
Providers and subcontractors have the choice to complete SHP provided training or complete training provided by other entities, so long that it meets all contractual agreements.
SHP Delegated Entity Oversight & Monitoring PolicySHP Provider Manual (training expectations)
The Centers for Medicare & Medicaid Services has developed training that can be accessed through the CMS Medicare Learning Network.
SHP’s Corporate Integrity Program is committed to complying with the laws and regulations relating to health care operations. This program strives to ensure compliance with federal, state and local laws and regulations, as well as upholding contractual, legal and ethical expectations.
Learn more about SHP Corporate Integrity
SHP Corporate Integrity policies (other resources and disciplinary standards can be found on the SHP Corporate Integrity site linked above).
SHP regularly audits conflict of interest. Upon hire and annually thereafter SHP requires that subcontractors/delegated entities, providers and contract staff sign a conflict-of-interest statement.
SHP Conflict of Interest Policy
SHP prohibits fraud, waste and/or abuse from all assets. The organization promotes operational accountability for the detection, control and prevention of FWA. SHP is committed to complying with all state and federal regulations through monitoring and oversight of operational processes.
Learn more about SHP’s commitment to comply with laws and regulations relating to health care operations.
SHP’s FWA Policy
For all training questions, please email SHPOCompliance@samhealth.org.
Samaritan Health Plans is committed to ethical business practices. We PRIDE ourselves on complying with all Medicare and Medicaid requirements for detecting, preventing and correcting fraud, waste and abuse and all compliance concerns.
If you have concerns about ethics, compliance or fraud, please contact us! Samaritan Health Plans has azero-tolerance policy for retaliation or retribution against any employee, affiliate or related entity who, in good faith, reports suspected misconduct or FWA.
If you suspect FWA or other compliance issues, please report it immediately:
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