D.C. Mun. Regs. tit. 29, r. 29-1905

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

Rule 29-1905 - PROVIDER ENROLLMENT PROCESS

1905.1

Prospective providers shall send a letter of interest to DDA to enroll as a Medicaid provider of Waiver services.

1905.2

Upon receipt of the letter of interest, prospective providers shall be invited by DDA via email to attend an informational meeting at DDA. Preceding the meeting, providers shall obtain a copy of the Medicaid provider enrollment application at DDS.dc.gov.

1905.3

Upon receipt of the Medicaid provider enrollment application by DDA, prospective providers shall receive an invitation to be interviewed or a denial letter. The denial letter shall be issued by DDA within sixty (60) business days from the time a Medicaid provider enrollment application is received by DDA and shall meet the requirements set forth in § 1905.5.

1905.4

If the Medicaid provider enrollment application is incomplete, DDA shall issue a denial letter, in accordance with § 1905.5, within sixty (60) business days from the time a Medicaid provider enrollment application is received.

1905.5

The denial letter shall include the following:

(a) The basis and reasons for the denial of the prospective provider's Medicaid provider enrollment application;

(b) The prospective provider's right to dispute the denial of the application and to submit written argument and documentary evidence to support its position; and

(c) Specific reference to the particular sections of relevant statutes and/or regulations.

1905.6

The provider interviews shall be conducted by an application review committee at DDA.

1905.7

Pursuant to the committee's recommendation and the overall merit of the application, DDA shall either issue a denial letter to the prospective providers or send the application of the DDA-recommended provider to DHCF for its review within thirty-five (35) business days of the committee's review date. The denial letter shall be issued in accordance with the requirements set forth in § 1905.5.

1905.8

Within thirty (30) business days of DHCF's receipt of DDA's recommendation, DHCF shall issue an approval or denial letter to the prospective providers. The denial letter shall be issued in accordance with the requirements set forth in § 1905.5.

1905.9

If a denial letter was issued by DDA or DHCF, the prospective provider shall be prohibited from submitting an application to enroll as a provider for a period of one year from the date the Medicaid provider enrollment application was received by DDA.

1905.10

Each provider shall be subject to the administrative procedures set forth in Chapter 13 of Title 29 DCMR; to the provider certification standards established by DDS, currently known as the Provider Certification Review process; to all policies and procedures promulgated by DDS that are applicable to providers during the provider's participation in the Waiver program; and to participation and cooperation in the reporting requirements pursuant to the Citizens with Intellectual Disabilities Constitutional Rights and Dignity Act of 1978, effective March 3, 1979 (D.C. Law 2-137; D.C. Official Code §§ 7-1301.02et seq.), as implemented by the Superior Court of the District of Columbia.

1905.11

Each provider who has been terminated or has voluntarily withdrawn from the Waiver program may not reapply to the Waiver program for a period of no less than one (1) year.

D.C. Mun. Regs. tit. 29, r. 29-1905

Final Rulemaking published at 51 DCR 10207 (November 5, 2004); as amended by Final Rulemaking published at 61 DCR 4406 (May 2, 2014); amended by Final Rulemaking published at 63 DCR 10445 (8/12/2016)

Authority: 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. 744; D.C. Official Code § 1-307.02 (2012 Repl. & 2013 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) (2012 Repl.)).