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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 29-50. MEDICAID REIMBURSEMENTS FOR PERSONAL CARE AIDE SERVICES |
Section 29-5007. DENIAL, SUSPENSION, REDUCTION OR TERMINATION OF SERVICES
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5007.1When PCA services are no longer desired by the beneficiary or their authorized representative, each Provider shall discontinue PCA services only after:
(a) Giving the beneficiary written notice that meets the requirements set forth in Subsection 5007.2;
(b) The thirty (30) day notice period prescribed in Subsection 5007.2 elapses; and
(c) The time for an appeal has expired, and the beneficiary has not filed an appeal.
5007.2Except as provided in Subsections 5007.5 and 5007.6, for Provider initiated suspensions, discharges or reductions of service, each Provider shall notify DHCF or its designated agent and the beneficiary or the beneficiary's authorized representative, in writing, no less than thirty (30) calendar days prior to any suspension, discharge or reduction in service, consistent with the requirements set forth in Federal and District law and rules. (See 42 C.F.R. §§ 431.200 et seq., D.C. Official Code § 4-205.55). The beneficiary’s record shall contain a copy of the notice and documentation of the date the notice was either personally served upon or mailed to the beneficiary or the beneficiary’s designated agent.
5007.3For denials, suspensions, terminations or reductions of service initiated by DHCF or its agent, DHCF or its designated agent shall notify the beneficiary or the beneficiary's authorized representative, in writing, no less than thirty (30) calendar days prior to any denial, suspension, termination or reduction of services, consistent with the requirements set forth in Federal and District law and rules (See 42 C.F.R. §§ 431.200 et seq., D.C. Official Code § 4-205.55).
5007. 4Consistent with Subsection 5014.3(g), if the PCA or PCA provider staff poses an immediate threat to the safety or well-being of the beneficiary, the provider must immediately review the threat, initiate an investigation, and provide alternate staff to the beneficiary.
5007.5If the behavior of a beneficiary poses an immediate threat to the safety and well-being of the PCA or PCA Provider staff, the Provider has the right to immediately suspend the beneficiary’s services or discharge the beneficiary Suspension of services shall not exceed thirty (30) calendar days.
5007.6 Within seventy-two (72) hours of suspension, the Provider shall notify the beneficiary or authorized representative in writing of the following:
(a)The grounds for suspension or discharge; and
(b)The beneficiary’s right to appeal the suspension or discharge.
5007.7At the end of the suspension period, the Provider may re-instate the beneficiary’s services or discharge the beneficiary in accordance with Subsection 5007.8. The Provider shall assist the beneficiary in transferring to another provider.
5007.8The beneficiary or the beneficiary’s representative shall be provided with a written notice of discharge at least fifteen (15) days before the effective date of the discharge, if the decision is made to discharge the beneficiary following suspension. The written notice shall comply with Federal and District law and rules (See 42 C.F.R. §§ 431.200 et seq., D.C. Official Code § 4-205.55).
5007.9In the event of a suspension or discharge, the Provider shall be responsible for ensuring that the beneficiary’s health, safety, and welfare are not threatened during the period of suspension or during the period after the beneficiary has been discharged and before transfer to another provider.