D.C. Mun. Regs. tit. 22, r. 22-A6504

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

Rule 22-A6504 - DENIAL OR DECERTIFICATION PROCESS

6504.1

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 a high quality transition planning service on a sustained and regular basis.

6504.2

An applicant may make minor corrections and substitutions to its application during the certification process. However, evidence of one (1) 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) The lack of demonstrated experience providing transition planning services by the applicant's clinical leadership, practitioners, and/or staff;

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

(f) An applicant's failure to respond in a timely manner to the Department's requests for information;

(g) History of poor performance; or

(h) Lack of behavioral health accreditation in accordance with § 6513.1.

6504.3

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. 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.

6504.4

The Director shall complete the administrative review within fifteen (15) business days of receipt of the applicant's request, to determine whether the certification denial complied with this subsection. The Director shall issue a written decision and provide a copy to the provider. The Director's decision shall be final and not subject to further appeal.

6504.5

An applicant and its executive leadership shall be prohibited from reapplying 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.

6504.6

The Department shall decertify existing transition planning providers who fail to comply with the certification requirements contained in this chapter. Evidence of one (1) 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 where there are two (2) or more changes made to the leadership staff within a 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 services;

(g) A provider's lack of financial resources to carry out its commitments and obligations under this chapter for the foreseeable future, as evidenced by an inability to pay all staff, or an inability to provide at least ninety (90) days of running capital as dictated by the provider's monthly operating budget;

(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 § 6513.1 or meet the timelines in § 6513.2.

6504.7

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

6504.8

Within fifteen (15) business days of the date on the notice of decertification, the provider may request an administrative review from the Director. Each request for an administrative review shall be in writing and contain a concise statement of the reason(s) why the provider asserts that decertification should not have occurred and any relevant supporting documentation.

6504.9

The Director shall complete the administrative review within fifteen (15) business days of receipt of the provider's request, to determine whether the decertification complied with this subsection. The Director shall issue a written decision and provide a copy to the provider.

6504.10

If the Director denies the appeal and approves the 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.

6504.11

Upon decertification, the transition planning provider and its executive leadership shall be prohibited from reapplying for certification 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 and show evidence that the grounds for the revocation have been corrected.

D.C. Mun. Regs. tit. 22, r. 22-A6504

Final Rulemaking published at 68 DCR 876 (1/15/2021); amended by amended by Final Rulemaking published at 70 DCR 3050 (3/10/2023)