D.C. Mun. Regs. tit. 22, r. 22-A3003

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-A3003 - DENIAL AND DECERTIFICATION PROCESS

3003.1

The Director may deny initial certification if the applicant fails to comply with any certification standard or the application fails to demonstrate the applicant's capacity to deliver high quality FSMHC services on a sustained and regular basis. The Director may also deny certification if the applicant proposes to operate a facility in an area already served by one or more providers. The Department's priority shall be to grant certification to applicants with the demonstrated capacity to deliver high quality FSMHC services that will address unmet needs of the behavioral health system.

3003.2

While applicants may make minor corrections and substitutions to their applications during the certification process, evidence of one or more of the following shall constitute good cause to deny the application for certification when the circumstances demonstrate deliberate misrepresentations, organizational instability, or the lack of preparedness or capacity to meet and sustain compliance with this chapter:

(a) An incomplete application;

(b) False information provided by applicant or contained in an application;

(c) One or more changes to an organizational chart during the application process;

(d) A facility that is inadequate in health, safety, size or configuration to provide FSMHC services consistent with high quality care and privacy standards;

(e) The lack of demonstrated experience providing FSMHC services by the applicant's clinical leadership, practitioners, or staff;

(f) An applicant's lack of financial resources to carry out its commitments and obligations under this chapter for the foreseeable future;

(g) An applicant's failure to timely respond to the Department of Behavioral Health's (Department's) requests for information;

(h) History of poor performance; or

(i) Lack of behavioral health accreditation in accordance with §3015.1.

3003.3

Upon written request submitted by the applicant and received by the Department within fifteen (15) business days of the certification denial, the Department shall provide an applicant an impartial administrative review of the decision. The Department shall conduct the administrative review to determine whether the certification denial complied with §§3003.1 -3003.2. Each request for an administrative review shall contain a concise statement of the reason(s) why the certification denial was in error. The Director shall issue a written decision within fifteen (15) business days. The Director's decision is final and not subject to further appeal. An applicant, its principals, and successor in interests shall not be allowed to reapply for certification for twelve (12) months following the date of denial.

3003.4

The Department shall decertify existing providers who fail to comply with the certification requirements contained in this chapter. Evidence of one or more of the following shall constitute good cause to decertify:

(a) An incomplete recertification application;

(b) False information provided by provider or contained in a recertification application;

(c) High staff turnover during the certification period demonstrating organizational instability;

(d) One or more documented violations of the certification standards during the certification period that evidence a provider's lack of capacity to meet and sustain compliance with this chapter;

(e) Claims audit error rate in excess of twenty-five percent (25%);

(f) Poor quality of care;

(g) A provider's lack of financial resources to carry out its commitments and obligations under this chapter for the foreseeable future;

(h) Failure to cooperate with Department investigations or lack of timely response to information requests; or

(i) Failure to obtain or maintain in good standing national accreditation in accordance with §3015.1 or meet the timelines in §3015.2.

3003.5

Nothing in this chapter requires the Director to issue an SOD or an NOI prior to decertifying an FSMHC. If the Director finds that there are grounds for revoking an FSMHC's certification, the Director shall issue a written notice of revocation setting forth the factual basis for the revocation, the effective date, and the FSMHC's right to request an administrative review.

3003.6

Within fifteen (15) business days of the date on the notice of revocation, the FSMHC may request an administrative review from the Director.

3003.7

Each request for an administrative review shall contain a concise statement of the reason(s) why the FSMHC asserts that it should not have its certification revoked and include any relevant supporting documentation.

3003.8

Each administrative review shall be conducted by the Director and shall be completed within fifteen (15) business days of the receipt of the provider's request.

3003.9

The Director shall issue a written decision and provide a copy to the FSMHC. If the Director approves the revocation of the FSMHC's certification, the FSMHC may, within fifteen (15) business days of the receipt of the Director's written decision, request a hearing under the D.C. Administrative Procedure Act, effective October 21, 1968 (Pub. L. 90-614, D.C. Official Code §§ 2-501 et seq.). The administrative hearing shall be limited to the issues raised in the administrative review request.

3003.10

Once certification is revoked, the FSMHC shall not be allowed to reapply for certification for a period of two (2) years following the date of the order of revocation. If an FSMHC reapplies for certification, the FSMHC must reapply in accordance with the established certification standards for the type of services provided, and show evidence that the grounds for the revocation have been corrected.

D.C. Mun. Regs. tit. 22, r. 22-A3003

Final Rulemaking published at 67 DCR 11929 (10/16/2020); amended by Final Rulemaking published at 70 DCR 3050 (3/10/2023)