D.C. Municipal Regulations (Last Updated: September 13, 2017) |
Title 26. INSURANCE, SECURITIES, AND BANKING |
SubTilte 26-A. INSURANCE |
Chapter 26-A19. INSURANCE COVERAGE FOR DRUG ABUSE, ALCOHOL ABUSE, AND MENTAL ILLNESS |
Section 26-A1904. DENIAL, SUSPENSION, OR REVOCATION OF A FACILITY CERTIFICATION
-
1904.1The Director may refuse to issue or renew or may revoke, or suspend a certification issued pursuant to this chapter for one or more of the reasons set forth in §1904.7 below.
1904.2Every applicant for or holder of a certification, or applicant for reinstatement after revocation, shall be afforded notice and an opportunity to be heard prior to the action of the Director, if the effect of the action would be one of the following:
(a)To deny an application for certification for cause which raises an issue of fact;
(b)To suspend a certification;
(c)To revoke a certification;
(d)To refuse to reinstate a certification;
(e)To issue a limited renewal certification; or
(f)To refuse to issue a renewal certification for any cause other than failure to pay the prescribed fees.
1904.3When the Director contemplates taking any action of the type specified in §1904.2(a) of these rules, the Director shall give to the applicant a written notice containing the following statements:
(a)That the applicant has failed to satisfy the Director as to the applicant’s qualifications;
(b)The respect in which the applicant has failed to satisfy the Director; and
(c)That the denial shall become final unless the applicant files a request for a hearing with the Director within fifteen (15) days of receipt of the notice.
1904.4When the Director contemplates taking any action of the type specified in §1904.2(b), (c), (d), (e), or (f) of these rules, the Director shall give the applicant a written notice containing the following statements:
(a)That the Director has sufficient evidence (setting forth the nature of the evidence) which, if not rebutted or explained, justifies taking the proposed action; and
(b)That the Director shall take the proposed action unless within fifteen (15) days of the receipt of the notice, the facility files with the Director a written request for a hearing or in the alternative submits documentary evidence for the Director's consideration before the Director takes final action.
1904.5If the facility does not respond to the notice within the time specified, the Director may, without a hearing, take the action contemplated in the notice. The Director shall inform the applicant, in writing, of the action taken.
1904.6If the facility chooses to submit documentary evidence but does not request a hearing, the Director shall consider the material submitted and take such action as is appropriate without a hearing. The Director shall notify the facility in writing of the action taken.
1904.7Grounds for suspension, revocation, limitation, or refusal to issue or renew a certification shall include the following:
(a)Failure to meet or maintain the standards required by these rules or the Act;
(b)Willful submission of false or misleading information to the Director in connection with an application for certification or related to certification procedures;
(c)Violation of these rules, the Act, or other laws and regulations of the District of Columbia or the United States relating to the operation of a facility and which are applicable to facilities operating in the District of Columbia;
(d)Failure to allow inspections pursuant to these rules;
(e)Failure to obey any lawful order of the Director, pursuant to these rules;
(f)Conviction of a member of the governing body, a Director, Administrator, the Chief Executive Officer, department head, or other key staff member, of a felony involving the management or operation of a facility, or which is directly related to the integrity of the facility or the public health or safety; or
(g)Any act which constitutes a threat to the public's health or safety.
1904.8If an applicant or certification holder scheduled for a hearing does not appear and no continuance has been granted, the Director may hear the evidence of the witnesses who have appeared, and the Director may proceed to consider the matter and render a decision on the basis of the evidence available.
1904.9If, because of accident, illness, or other good cause, a person fails to receive a hearing or fails to appear for a requested hearing, and has been diligent in bringing the matter to the Director's attention, the Director may grant appropriate relief.