Section 29-9703. PROGRAM ADMINISTRATION

 

9703.1 Each Provider shall have a current organizational chart that clearly identifies the organizational structure, lines of authority, staffing levels, and the use of contracted staff.

 

9703.2 Each Provider shall have a governing body with oversight responsibility for administrative and programmatic policy development, monitoring and implementation.

 

9703.3 A Provider shall be prohibited from waiving liability for the delivery of services when they assign contract authority to any other entity for services provided under a participant’s ADHP plan of care.

 

9703.4 Each Provider shall develop and implement written policies and procedures to comport to the following program requirements:

 

(a) A description of the program’s mission statement and goals;

 

(b) The roles and responsibilities of its governing body;

 

(c) A fee schedule including a description of the services to be provided and that are included in the Medicaid per diem rates established in accordance with Section 9723;

 

(d) Participant admission and discharge procedures;

 

(e) A description of the ADHP’s approach for implementing the participant’s person-centered plan of care;

 

(f) Nutritional standards including guidelines for meal preparation, menu planning and meeting the individualized nutritional needs of each participant;

 

(g) Participant rights and responsibilities procedures consistent with the requirements set forth in Section 9712, and contact information about agencies or programs which can respond to complaints;

 

(h) Hours and days of operation;

 

(i) Personnel standards for hiring, requirements for professional licensure and certification, performance assessments, grievances, and staff training for all staff who deliver services;

 

(j) ADHP site environmental standards;

 

(k) Health and wellness standards;

 

(l) Safety and emergency preparedness procedures;

 

(m) Medication administration, storage, and record keeping requirements to conform with requirements described under Section 9707; 

 

(n) Quality assurance procedures identifying performance measures to evaluate the ADHP program’s effectiveness, and weaknesses, including performance measures to ensure service coordination with services provided by other service providers;

 

(o) Processes for reporting, investigating and addressing ADHP participants’ incidents, and complaints;

 

(p) Financial, administrative and participant record keeping requirements; 

 

(q) A compliance plan in accordance with guidance from Department of Health and Human Services, Office of Civil Rights, available at:  http://www.hhs.gov/ocr/privacy/hipaa/administrative/combined/hipaa-simplification-201303.pdf to incorporate appropriate administrative, physical, and technical safeguards to protect the privacy of ADHP participants and ensure compliance with the Health Insurance, Portability, and Accountability Act of 1996, approved August 21, 1996 (Pub. L. No. 104-191, 110 Stat. 1936) (HIPAA); and

 

(r) A community outreach and education plan which demonstrates how the ADHP will: (1) develop and maintain linkages with other community-based organizations that serve adults with chronic medical conditions; and (2) provide annual outreach for hard to reach populations.

 

9703.5Each ADHP shall notify the DHCF within twenty-four (24) hours in writing, in the following situations:

 

(a) Fire, serious accident, serious injury, neglect, abuse or other incidents that impact the health or safety of a participant;

 

(b) Evidence of serious communicable disease contracted by staff or participants;

 

(c) The death of a participant at, en route to, or en route from, the program site; and

 

(d) Changes in professional staff or a reduction of work force that may result in a disruption of service delivery. 

 

9703.6If a provider intends to relocate to a new program site, each ADHP provider shall obtain DHCF’s approval of the new site by undergoing a new Provider Readiness review and notifying the DHCF at least sixty (60) days in advance of the actual move.

 

9703.7If a provider intends to withdraw from the Medicaid program, each ADHP provider shall notify DHCF at least ninety (90) days in advance of the provider’s intention to withdraw, and supplement the notification with a transition plan, to prevent service gaps for the participants at least sixty (60) days in advance of the provider’s intention to withdraw.

 

9703.8Each ADHP shall maintain minimum insurance coverage as follows:

 

(a) Blanket malpractice insurance for all employees in the amount of at least one million dollars ($1,000,000) per incident;

 

(b)   General liability insurance covering personal property damages, bodily injury, libel and slander of at least one million dollars ($1,000,000) per occurrence; and

 

(c)   Product liability insurance, where applicable.

 

 

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 (2014 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 63 DCR 1031 (January 29, 2016).