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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 22. HEALTH |
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SubTilte 22-B. PUBLIC HEALTH AND MEDICINE |
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Chapter 22-B55. STANDARDS FOR PREPAID PROVIDERS QUALIFYING TO SERVE DISTRICT OF COLUMBIA MEDICAID RECIPIENTS |
Section 22-B5504. REQUIRED INFORMATION
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5504.1 Each QO shall submit the following information to the Department, at the time of application for a contract:
(a)A copy of the basic organizational documents of the QO, such as articles of incorporation, and each amendment;
(b)A copy of the by-laws or similar documents regulating conduct of the internal affairs of the QO;
(c)A description of the organization’s ownership and a list of major owners (stockholders having five percent (5%) or more of outstanding shares);
(d)A list of board members and their affiliations;
(e)A roster of key personnel and their qualifications;
(f)A list of subcontracts and a copy of each type of subcontract;
(g)The number of clinical, administrative and marketing employees;
(h)The form of evidence of coverage to be issued to enrollees;
(i)For on-going organizations, financial statements showing the organizations assets, liabilities and sources of financial support, including the most recent audited financial statement;
(j)For start-up organizations, pro forma operating statements and balance sheets and a statement as to sources of working capital and other sources of funding;
(k)A description of the proposed method of marketing;
(l)A description of the enrollee grievance process;
(m)A description of the procedures and programs to assure the availability and accessibility of high quality services;
(n)A description of the enrollment process;
(o)A statement of policies and procedures governing claim payments to providers and distribution of revenues to owners;
(p)A written description of the medical record, and statistical reporting systems;
(q)A statement on the organization’s background and experience in serving low income, diversified population groups in the District; and
(r)A statement of the proposed methods of handling out-of-plan emergency and out-of-area coverage.
5504.2 The QO shall notify the Department’s Office of Health Care Financing in writing within thirty (30) days of any material modifications cited under §5504.1 on file.