Section 29-9400. MEDICAID PROVIDER AND SUPPLIER GENERAL PROVISIONS

 

9400.1 An individual or entity that is engaged in the businesses of healing arts (“provider”) or supplying health and medical supplies (“supplier”) and desires to receive reimbursement for services provided to District of Columbia Medicaid beneficiaries shall be screened and enrolled pursuant to the requirements in this chapter.

 

9400.2Providers and suppliers shall be authorized to deliver health services and supplies to Medicaid beneficiaries upon notification from the Department of Health Care Finance that the requirements for enrollment have been met.

 

9400.3To initiate the enrollment process, a prospective Medicaid provider or supplier (“Applicant”) shall submit a completed D.C. Medicaid Provider/Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) Provider/Supplier Application (“Application”) to the Department of Health Care Finance (“DHCF”). 

 

9400.4Applicants also shall be subject to screening through any of the following:

 

(a) Ownership and Financial Disclosures;

 

(b) Criminal Background Checks;

 

(c) Fingerprinting; and/or

 

(d) Pre and Post Enrollment Site Visits.

 

9400.5An Applicant shall submit to screening, produce all documentation listed on the Application, and adhere to the guidance and timeframes issued by DHCF throughout the enrollment or revalidation of enrollment process.

 

9400.6DHCF shall revalidate all enrolled suppliers of DMEPOS every three (3) years, and all other Medicaid providers every five (5) years, in accordance with 42 C.F.R. § 455.414.  The dates for revalidation of enrollment shall be calculated beginning on the date that the Director of DHCF (“Director”), or a designee, signs the Provider Agreement.

 

9400.7DHCF shall screen any Applicant that has not been screened by Medicare or another state’s Medicaid program within the twelve (12) month period that precedes initial enrollment or revalidation of enrollment.

 

9400.8For purposes of screening and enrollment, prospective providers and suppliers shall be classified either as “in-District” or “out-of-District” providers. 

 

9400.9In accordance with 42 C.F.R. § 455.470, DHCF may impose a temporary moratorium on the enrollment of any provider category or supplier if the Secretary of the Department of Health and Human Services (“Secretary”) imposes a moratorium on the same provider category or supplier’s participation in the Medicaid program.

 

9400.10In accordance with 42 C.F.R. § 455.470(b), DHCF may impose a temporary moratorium on the enrollment of new providers and suppliers, or otherwise limit the number of enrolled providers and suppliers, if DHCF identifies significant potential for fraud, waste, and abuse that is also aligned with the Secretary’s findings.

 

9400.11Temporary moratoria shall be imposed for initial periods equal to one hundred eighty (180) days, and may be extended in one hundred eighty (180)-day increments. 

 

 

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 (2006 Repl. & 2012 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) (2008 Repl.)).

source

Final Rulemaking published at 60 DCR 10041 (July 12, 2013).