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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 29-41. MEDICAID REIMBURSEMENT FOR INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES |
Section 29-4104. SUPPLEMENTAL PAYMENTS FOR QUALITY OF CARE IMPROVEMENTS
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4104.1 Consistent with the requirements set forth in the Stevie Sellows Intermediate Care Facility for the Intellectually and Developmentally Disabled Quality Improvement Act of 2005, effective March 8, 2006 (D.C. Law 16-68; D.C. Official Code §§ 47-1270 et seq.), implementing rules, and subsequent amendments, beginning in FY 2014 an ICF/IID that meets the criteria in this section shall be eligible to receive a supplemental payment based on the cost of training provided to employees other than managers, administrators, and contract employees.
4104.2 In addition to the aggregate per diem described in § 4102, an ICF/IID may receive an additional payment for participation in quality improvement initiatives that are intended to increase the qualifications of employees by making available educational opportunities.
4104.3 To qualify for a supplemental payment for quality improvements under this Section for a fiscal year, an ICF/IID shall, by June 30th of the preceding fiscal year, provide DHCF with documentation verifying that it:
(a) Has a legally binding written agreement with its employees to fund quality of care improvements through measurable efforts to develop and improve staff skills by increasing staff training and educational opportunities;
(b) Has written procedures outlining the process, such as arbitration, for employees to follow to enforce this agreement. The process shall:
(1) Be expeditious;
(2) Be economical for the employees; and
(3) Provide for a neutral decision maker to resolve disputes; and
(c) Has provided copies of the agreement and the written procedures to its employees and their representatives.
4104.4 To establish the cost amount for purposes of determining the facility’s supplemental payment amount, an ICF/IID shall provide DHCF with documentation verifying the amount of training costs no later than June 30th of the preceding fiscal year.
4104.5 The training cost amount shall include the cost of providing training for employees other than managers, administrators, and contractors, and shall be the actual costs incurred by the facility in providing training to these employees. For training costs to be included, the training shall be:
(a) Related to patient care;
(b) Related to improving the skills, competency, and qualifications of employees in providing care; and
(c) Approved by DHCF.
4104.6 In order to be eligible for the supplemental payment, an ICF/IID shall incur costs and provide DHCF with evidence that payment has been made in full. Acceptable forms of evidence shall include a copy of any invoice(s) for training costs and cancelled check(s) reflecting the facility’s payment of the invoice(s).
4104.7 All supplemental payments shall be subject to a uniform percentage of thirteen percent (13%) for administrative costs for FY 2013. The administrative cost percentage may be adjusted in subsequent fiscal years. Adjusted rates will be set forth in the D.C. Register.
4104.8 Supplemental payments associated with the costs of implementing quality improvement initiatives shall be recorded as an offset to the costs incurred, and shall be included in the cost report submitted annually.
4104.9 The supplemental payments described in this section shall not be used to enhance training or educational opportunities for management, administration, and contractual staff.
4104.10 The amount and availability of the supplemental payment shall be contingent upon the availability of funding from DHCF. If the total amount of payments to be made to all eligible providers exceeds the amount of available funds, then payments made to all eligible facilities shall be proportionately reduced.
4104.11 DHCF shall issue a Notice of Eligibility and Proposed Reimbursement to each provider within sixty (60) days of receipt of all required information. The written notice shall contain at a minimum all of the following information:
(a) A determination indicating whether the provider is eligible or ineligible to receive the supplemental payment;
(b) If a provider is determined to be ineligible to receive the supplemental payment, a written statement explaining why the facility is ineligible; and
(c) Language describing the procedures and timeframes for requesting an administrative review with DHCF.
4104.12 A provider who disagrees with the Notice of Eligibility and Proposed Reimbursement may request an administrative review by submitting a written request for an administrative review to DHCF within thirty (30) days after the date of the Notice of Eligibility and Proposed Reimbursement.
4104.13 The written request for an administrative review shall include:
(a) The reason(s) for the request, including an identification of the specific item(s) to be reviewed; and
(b) Supporting documentation.
4104.14 No later than ninety (90) days after receipt of all requests for administrative review DHCF shall issue a Final Notice of Eligibility and Reimbursement to each provider that has applied for the supplemental payment. The notice shall contain at a minimum the following information:
(a) A final determination indicating whether the provider is eligible to receive the supplemental payment. If ineligible, the notice shall contain a written statement explaining why the provider is ineligible;
(b) The total amount of the supplemental payment, including the annual salary, benefit, and training cost amounts;
(c) The annul number of employee hours excluding managers, administrators, and contract employees;
(d) The timeframe for payment of the supplemental payment; and
(e) Language describing the procedures and timeframes for requesting an appeal with the Office of Administrative Hearings (OAH).
4104.15 A provider who disagrees with the Final Notice of Eligibility and Reimbursement may file an appeal with the OAH within forty-five (45) days of the date of the Final Notice of Eligibility and Reimbursement.
4104.16 Any adjustments to the supplemental payment as a result of a decision rendered by the OAH shall be offset against payments the following fiscal year.