Section 29-8901. METHODOLOGY FOR VOLUME REQUIREMENTS

 

8901.1 An eligible professional shall establish and demonstrate, based on individual and group practice methodology, compliance with the following volume requirements:

 

(a) An eligible professional shall have at least thirty percent (30%) of the professional's patient volume covered by Medicaid, except that:

 

(1) A board-certified pediatrician who does not practice at a FQHC shall have a minimum of twenty percent (20%) of patient encounters; and

 

(2) Any eligible professional predominately practicing at a FQHC shall have at least thirty percent (30%) of patient volume attributable to needy individuals.

 

(b) An eligible professional shall calculate individual Medicaid patient volume by dividing the total Medicaid patient encounters (in and out of the District) in any continuous ninety (90) day period in the calendar year (CY) preceding the eligible professional’s payment year, or in the twelve (12) months before the eligible professional’s attestation; by the total patient encounters in the same ninety (90) day period;

 

(c) Subject to 42 C.F.R. § 495.306(h), an eligible professional shall calculate group Medicaid patient volume by dividing the total Medicaid patient encounters (in and out of the District across the entire group or clinic) in any continuous ninety (90) day period in the CY preceding the eligible professional’s payment year, or in the twelve (12) months before the eligible professional’s attestation; by the total patient encounters (in and out of the District across the entire group or clinic); and

 

(d) An eligible professional practicing in a FQHC shall calculate needy individual patient volume by dividing the total needy individual patient encounters in any continuous ninety day period in the CY preceding the eligible professional’s attestation; by the total patient encounters in the same ninety (90) day period. 

 

8901.2 An eligible acute care hospital shall have at least ten percent (10%)  Medicaid patient volume based on individual methodology as calculated below:

 

(a) An eligible hospital shall divide the total Medicaid patient encounters (in and out of the District) in any continuous ninety (90) day period in the preceding fiscal year (FY), or in the twelve (12) months before the eligible hospital’s attestation; by

 

(b) The total patient encounters in the same ninety (90) day period to calculate individual Medicaid patient volume.

 

8901.3 An eligible children’s hospital shall be exempt from volume requirements of Subsections 8901.1 through 8901.2. 

 

 

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.744; D.C. Official Code § 1-307.02 (2013 Supp.)), 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 61 DCR 237 (January 10, 2014).