2260796 Private Clinic Reimbursement

 

DEPARTMENT OF HEALTH CARE FINANCE

 

NOTICE OF EMERGENCY AND PROPOSED RULEMAKING

 

 

The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in 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 (2006 Repl. & 2011 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.)), hereby gives notice of the adoption, on an emergency basis, of an  amendment to  section 943 of chapter 9 of title 29 of the District of Columbia Municipal Regulations (DCMR),  entitled “Medicaid Clinic Services and Reimbursement.”

 

These rules will amend Medicaid reimbursement for physician and specialty services delivered by private clinic providers. On October 17, 2011, the Centers for Medicare and Medicaid Services (CMS) approved a State Plan Amendment reducing the Medicaid reimbursement rates for fee-for-service physicians and specialty services rates from one hundred percent (100%) to eighty percent (80%) of the Medicare rate, effective January 1, 2011.  

 

Emergency action is necessary for the immediate preservation of the health, safety, and welfare of Medicaid beneficiaries. Clinics affected by this rule contribute to the District’s health care safety net established for Medicaid beneficiaries. This safety net affords access to quality services essential to maintaining the integrity of the District of Columbia’s public health system.    Physician and specialty services rates for private clinic providers should be amended immediately to bring the District into compliance with the Medicaid State Plan; thereby avoiding a gap in resources crucial to service delivery under the safety net.   

 

The emergency rulemaking was adopted on March 28, 2012, and became effective on that date. These emergency rules will remain in effect for one hundred and twenty days (120) or until July 25, 2012, unless superseded by publication of a Notice of Final Rulemaking in the D.C. Register. The Director also gives notice of the intent to take final rulemaking action to adopt these rules not less than thirty (30) days after the date of publication of this notice in the D.C. Register.

 

Section 943 (MEDICAID CLINIC SERVICES AND REIMBURSEMENT) of chapter 9 (MEDICAID PROGRAM) of title 29 (PUBLIC WELFARE) is amended as follows:

 

Subsection 943.19 is amended to read as follows:

 

943.19             Reimbursement for private clinic medical services shall be governed in accordance with the provisions set forth in 29 DCMR § 995.       

 

Comments on this rule should be submitted in writing to Linda Elam, Ph.D., Medicaid Director, Department of Health Care Finance, Government of the District of Columbia, 899 North Capitol Street, NE, 6^th Floor, Washington, DC 20002, via telephone on [phone], via email at [e-mail], or online at www.dcregs.dc.gov,  within thirty (30) days of the date of publication of this notice in the D.C. Register.  Additional copies of this rule are available from the above address.