Section 29-5012. ADMINISTRATION

 

5012.1NPI numbers for Providers and staffing agencies, and all personnel delivering PCA services shall be included in all Medicaid billings.

 

5012.2Each Provider shall have a current organizational chart that clearly describes the organizational structure, management responsibilities, staff responsibilities, lines of authority, and use of any contractors.

 

5012.3 Each Provider shall maintain current copies of all fully executed contracts including all staffing agency contracts pertaining to the delivery of PCA  services and an updated listing of professional staff licensure and registration information and all PCA certifications in the Provider’s office and make them available to DHCF, CMS, and other authorized government officials or their agents when requested. 

 

5012.4Each Provider shall maintain a copy of each license held by their employees and employees of any staffing agency utilized by the Provider for the delivery of PCA services.

 

5012.5A Provider shall be prohibited from waiving liability or assigning contract authority to any other entity for covered services provided to Medicaid beneficiaries.

 

5012.6Each Provider shall provide to all employees and contractors (such as staffing agencies providing staffing) a current policy manual in an electronic or hard-copy form, which sets forth all of its policies and procedures.

 

5012.7Each policy manual shall include, but not be limited to, the following information:

 

(a)A description of the services to be provided;

 

(b)Procedures for beneficiary care;

 

(c)The reimbursement methodology or fee schedules;

 

(d)Operational schedules;

 

(e)Quality assurance standards;

 

(f)A statement of beneficiary rights and responsibilities;

 

(g)Financial and record-keeping requirements;

 

(h)Procedures for emergency care, infection control and reporting of incidents;

 

(i)A description of staff positions and personnel policies, which shall be reviewed annually, revised as necessary, and dated at time of review;

 

(j)Policies and procedures for hiring, performance assessments, grievances, and in-service training of all PCAs who deliver services, regardless of whether the PCA is an employee of the Provider or is secured through a staffing  agency;

 

(k) Policies and procedures for providing advance notice to beneficiaries in accordance with Section 5007; and

 

(l)  Policies, procedures, and presentation materials for owners, managers, employees and contractual staff for in-service training on the following subjects:

 

(1)Compliance with these regulations;

 

(2) Compliance with federal and District False Claims Acts;

 

(3) Preventing, detecting, and reporting fraud, waste, and abuse; and

 

(4)  Rights of employees to be protected as whistleblowers.

 

 

authority

An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes approved December 27, 1967 (81 Stat.774; D.C. Official Code § 1-307.02 (2012 Repl.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).

source

Final Rulemaking published at 59 DCR 1760, 1779 (March 2, 2012); as amended by Final Rulemaking published at 60 DCR 15537 (November 8, 2013); as amended by Final Rulemaking published at 63 DCR 14134 (November 18, 2016).