D.C. Mun. Regs. tit. 22, r. 22-A3403

Current through Register Vol. 71, No. 49, December 6, 2024
Rule 22-A3403 - DENIAL OF CERTIFICATION OR DECERTIFICATION PROCESS
3403.1

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 MHRS on a sustained and regular basis.

3403.2

To avoid an over-concentration of providers in areas with existing providers and to encourage increased access to underserved areas of the District, the Director may 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 MHRS services that will address unmet needs of the behavioral health system.

3403.3

While applicants may make minor corrections and substitutions to its application 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 anorganizational chart during the application process;
(d) A facility that is inadequate in health, safety, size, or configuration to provide MHRS consistent with high quality care and privacy standards;
(e) The lack of demonstrated experience providing MHRS by the applicant's clinical leadership, practitioners, and/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's requests for information;
(h) History of poor performance; or
(i) Lack of behavioral health accreditation in accordance with §3433.1.
3403.4

Within fifteen (15) business days of the date on the certification denial, an applicant may make a request for an administrative review of the decision from the Director. The Director shall conduct the administrative review to determine whether the certification denial complied with §3403.1.

3403.5

Each request for an administrative review shall be in writing and contain a concise statement of the reason(s) why the applicant asserts that the certification denial was in error and any relevant supporting documentation.

3403.6

The Director shall complete the administrative review within fifteen (15) business days of receipt of the applicant's request.

3403.7

The Director shall issue a written decision and provide a copy to the provider. The Director's decision is final and not subject to further appeal.

3403.8

An applicant and its executive leadership shall not be allowed to reapply for certification for twelve(12) months following the date of the initial denial or, if applicable, the date of the denial pursuant to the Director's administrative review.

3403.9

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 §3433.1 or meet the timelines in §3433.2.
3403.10

Nothing in this chapter requires the Director to issue a SOD prior to decertifying an MHRS provider. If grounds for decertification have been met, the Director will issue a written notice of decertification setting forth the factual basis for the decertification, the effective date, and right to request an administrative review.

3403.11

Within fifteen (15) business days of the date on the notice of decertification, the provider may request an administrative review from the Director. The Director shall conduct the administrative review to determine whether the decertification complied with §3403.7.

3403.12

Each request for an administrative review shall contain a concise statement of the reason(s) why the provider asserts that decertification should not have occurred and any relevant supporting documentation.

3403.13

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.

3403.14

The Director shall issue a written decision and provide a copy to the provider. If the Director approves decertification, the provider may within fifteen (15) business days of receipt of the Director's written decision request a hearing under the D.C. Administrative Procedure Act, D.C. Official Code §§ 2-501, et seq. The administrative hearing shall be limited to the issues raised in the administrative review request. The decertification shall be stayed pending resolution of the hearing.

3403.15

Upon decertification, the MHRS provider and its executive leadership shall not be allowed to reapply for certification for any new services, including the service subject to decertification, for a period of two (2) years following the later of the date of the decertification letter or the date of the decertification order (if applicable). If a provider reapplies for certification, the provider shall 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-A3403

Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); as amended by Notice of Final Rulemaking published at 59 DCR 4785 (May 11, 2012); amended by Final Rulemaking published at 67 DCR 10674 (9/4/2020); amended by Final Rulemaking published at 70 DCR 3050 (3/10/2023), effective date corrected to 4/7/2023, by Errata Notice published at 71 DCR 4474 (4/19/2024).
Authority: The Director of the Department of Mental Health (Department), pursuant to the authority set forth in sections 104 and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05 (2008 Repl.)).