D.C. Mun. Regs. tit. 22, r. 22-B4403

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

Rule 22-B4403 - PROHIBITION OF EXCLUSIONARY ADMISSIONS POLICIES

4403.1

A CON holder shall be out of compliance with § 4400.4, if it uses an admissions practice that has the effect of excluding persons who are eligible for uncompensated care under § 4406.

4403.2

Prohibited admissions practices include the following:

(a) Limiting admission to patients who are referred by physicians with staff privileges at the CON holder's facility (or facilities);

(b) Maintaining an operational structure that includes few or no physicians with staff privileges who will treat persons who are eligible for uncompensated care; or

(c) Requiring advance deposits (preadmission or pre-service deposits) from persons who qualify or appear to qualify for uncompensated care before admitting or serving these persons.

4403.3

A CON holder may have in effect a policy or practice described in § 4403.2(a) and still comply with this chapter if the CON holder makes alternative arrangements to treat those persons who would otherwise be unable to gain admission to, or obtain services available from, the CON holder. Alternative arrangements may include the following:

(a) Authorizing the individual's physician, if licensed and otherwise qualified, to treat the patient at the facility even though the physician does not have staff privileges at the facility;

(b) Obtaining the voluntary agreement of physicians with staff privileges at the facility to accept referrals regularly of patients who do not have a physician (e.g. rotating referrals to the physicians with staff privileges);

(c) Requiring acceptance of referrals of patients who do not have a physician as a condition of obtaining or renewing staff privileges;

(d) Establishing a hospital-based primary care clinic through which patients needing hospitalization may be admitted; or

(e) Hiring or contracting with qualified physicians to treat patients who do not have private physicians.

4403.4

A CON holder need not require all its staff physicians to accept Medicaid or Medicare patients to remedy a violation of § 4403.2(b). If the Department of Health, Medical Assistance Administration, determines that a CON holder or CON applicant is out of compliance with Medicaid or Medicare obligations, the CON applicant or CON holder shall be deemed out of compliance with admissions and service requirements until the CON applicant or CON holder takes steps to ensure that Medicaid and Medicare program beneficiaries have full access to all of the CON applicant's or CON holder's available services.

4403.5

A CON holder that engages in a practice prohibited by § 4403.2(c) is not required to forego the use of a deposit policy in all situations. The CON holder can remedy this violation by making alternative arrangements to ensure that persons who probably can pay for services are not denied them simply because they do not have the available cash at the time services are requested. A CON holder shall not deny admission or a service to a person who probably can pay because of the person's inability to pay a deposit at the time the person requests admission or a service.

D.C. Mun. Regs. tit. 22, r. 22-B4403

Final Rulemaking published at 36 DCR 5819 (August 11, 1989); as amended by Final Rulemaking published at 52 DCR 8258 (September 2, 2005); as amended by Final Rulemaking published at 53 DCR 4808 (June 16, 2006)

Authority: This chapter was originally enacted under the authority of the District of Columbia Certificate of Need Act of 1980, effective September 16, 1980 (D.C. Law 3-99; D.C. Official Code, §§ 44-1801 to 44-1817 (2001 ed.)), and amended by the District of Columbia Certificate of Need Act of 1980 Amendment Act of 1987, effective March 16, 1988 (D.C. Law 7-90; 35 DCR 710 (February 5, 1988)). Subsequent to the enactment of this chapter, the District of Columbia Certificate of Need Act of 1980 was repealed by § 22 of the Health Services Planning Program Act of 1992, effective March 16, 1993 (D.C. Law 9-197; 39 DCR 9195 (December 11, 1992)). Later authority for the regulation of Certificates of Need was found at D.C. Official Code §§ 44-401 to 44-421 (2001 ed.); Mayor's Reorganization Plan No. 3 of 1986; and Mayor's Order 95-162, dated December 4, 1995.