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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 29-4111. ALTERNATIVE SANCTIONS FOR ICFSIID-NON-IMMEDIATE JEOPARDY
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4111.1 In accordance with Section 1902(i)(1)(B) of the Social Security Act, the District of Columbia may impose alternative sanctions against an ICF/IID when that facility fails to meet the CoPs, but the violation does not place beneficiary health or safety in immediate jeopardy.
4111.2 In lieu of terminating the provider agreement, DHCF may impose one (1) or more alternative sanctions against an ICF/IID as set forth below:
(a) Denial of payment, as described in § 4112;
(b) Directed Plan of Correction (DPoC), as described in § 4113;
(c) Directed In-Service Training (DIST), as described in § 4114; or
(d) State Monitoring, as described in § 4115.
4111.3 DHCF shall determine the appropriateness of alternative sanctions against an ICF/IID upon notification by the Department of Health that an ICF/IID is not in compliance with any of the federal CoPs. A determination to terminate a provider from the Medicaid program, or to impose an alternative sanction shall be made based on the following factors:
(a) Seriousness of the violation(s);
(b) Number and nature of the violation(s);
(c) Potential for immediate and serious threat(s) to ICF/IID residents;
(d) Potential for serious harm to ICF/IID residents;
(e) Any history of prior violation(s) and/or sanction(s);
(f) Actions or recommendations of DDS, developmental disability advocacy groups, or health care entities;
(g) Mitigating circumstances; and
(h) Other relevant factors.
4111.4DHCF shall issue a written notice to each ICF/IID notifying the facility of termination of the Medicaid provider agreement or the imposition of an alternative sanction. The written notice shall comply with District and federal law and rules.
4111.5All costs associated with the imposition of an alternative sanction against an ICF/IID pursuant to these rules shall be borne by the facility.