Section 29-9404. SCREENING PROVIDERS OR SUPPLIERS CLASSIFIED AS "HIGH RISK"

 

9404.1 Pursuant to 42 C.F.R. § 455.450, the following provider and supplier types shall be classified within the “High Risk” category:

 

(a) Home Health Agencies (“HHAs”) and

 

(b) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (“DMEPOS”) suppliers.

 

9404.2 Screening for providers or suppliers classified as “High Risk” shall include the following:

 

(a) Verification that the provider or supplier meets requirements set forth in the D.C. Health Occupations Revision Act of 1985, as amended, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code  § 3-1201.01 et seq.) and implementing rules, as well as all other applicable Federal and District laws and regulations;

 

(b) Verification of appropriate licensure, including licensure in states other than the District, in accordance with 42 C.F.R. § 455.412;

 

(c) Both pre- and post-enrollment database checks in order to ensure the provider or supplier continues to meet the enrollment criteria that corresponds to its provider or supplier type, in accordance with 42 C.F.R. § 455.436;

 

(d) On-site visits conducted in accordance with 42 C.F.R. § 455.432;

 

(e) Criminal background checks, pursuant to 42 C.F.R. § 455.434; and

 

(f) Submission of fingerprints, pursuant to 42 C.F.R. § 455.434, for all providers or individuals who maintain a five-percent (5%) or greater ownership interest in the provider or supplier.

 

 

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).