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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-13. MEDICAID PROGRAM ADMINISTRATIVE PROCEDURES |
Section 29-1304. SUSPENSION FOR CONVICTION OF PROGRAM RELATED OFFENSE
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1304.1For the purposes of this section, the term "suspension" means that items or services furnished by a specified provider who has been convicted of a program related offense in a Federal, District of Columbia, State or local court shall not be reimbursed under Medicaid.
1304.2The Director shall, in accordance with 42 CFR 455.210, suspend from the District's Medicaid Program any party who has been suspended from participation in Medicare for conviction of a program-related crime.
1304.3The Director shall suspend any convicted party who is not eligible to participate in Medicare whenever HCFA directs the Director to take the action.
1304.4Any suspension imposed by the Director under §1304.3 shall, at a minimum, be effective on the date and for the period specified by HCFA.
1304.5Except as authorized by federal regulations, reimbursement for services furnished directly or under the supervision of a suspended party shall not be made during the period of suspension.
1304.6Nothing in §1304.4 shall prevent the Director from imposing other sanctions against the provider under these rules.
1304.7If the Director proposes to terminate the provider agreement or to suspend the provider for a period of greater duration than that specified by HCFA, then prior to taking the action, the Director shall follow the procedures specified for exclusion and termination actions as set forth in §1303.
1304.8If the Director's suspension is effective on the date and for the period specified by HCFA, then the convicted party shall be notified in writing by the Director regarding the effective date for the suspension.
1304.9The party shall not be entitled to a hearing under this chapter with regard to the suspension by HCFA. In this case, any right to appeal shall be provided by HCFA, not by the Director.