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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-B5512. SANCTIONS FOR NON-COMPLIANCE
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5512.1 If the Department determined that a QO has failed to comply with this chapter or other applicable federal and District laws and regulations, the Department may do any of the following:
(a)Suspend further enrollment of Medicaid recipients;
(b)Withhold all or part of the monthly payments; and
(c)Terminate the contract within thirty (30) days from date of notice to the QO.
5512.2 Before taking any action described in §5512.1, the Department shall provide written notice to the QO, which shall include the following:
(a)Identification of the sanction to be applied;
(b)The basis for the Department’s determination that the sanction should be taken;
(c)The effective date of the sanction; and
(d)The timeframe and procedure for the QO to appeal the Department’s determination, including a time, place and date that a hearing on the matter will be held at the written request of the QO.
5512.3 The Department shall give reasonable written notice to Medicaid recipients enrolled in the QO and others who may be affected by the proposed sanction.