D.C. Mun. Regs. tit. 29, r. 29-4111

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

Rule 29-4111 - ALTERNATIVE SANCTIONS FOR ICFs/IID - NON-IMMEDIATE JEOPARDY

4111.1

In accordance with Section 1902(i)(1)(B) of the Social Security Act, the District of Columbia may impose alternative sanctions against an ICF/IID when that facility fails to meet the CoPs, but the violation does not place beneficiary health or safety in immediate jeopardy.

4111.2

In lieu of terminating the provider agreement, DHCF may impose one (1) or more alternative sanctions against an ICF/IID as set forth below:

(a) Denial of payment, as described in§ 4112;

(b) Directed Plan of Correction (DPoC), as described in§ 4113;

(c) Directed In-Service Training (DIST), as described in§ 4114; or

(d) State Monitoring, as described in§ 4115.

4111.3

DHCF shall determine the appropriateness of alternative sanctions against an ICF/IID upon notification by the Department of Health that an ICF/IID is not in compliance with any of the federal CoPs. A determination to terminate a provider from the Medicaid program, or to impose an alternative sanction shall be made based on the following factors:

(a) Seriousness of the violation(s);

(b) Number and nature of the violation(s);

(c) Potential for immediate and serious threat(s) to ICF/IID residents;

(d) Potential for serious harm to ICF/IID residents;

(e) Any history of prior violation(s) and/or sanction(s);

(f) Actions or recommendations of DDS, developmental disability advocacy groups, or health care entities;

(g) Mitigating circumstances; and

(h) Other relevant factors.

4111.4

DHCF shall issue a written notice to each ICF/IID notifying the facility of termination of the Medicaid provider agreement or the imposition of an alternative sanction. The written notice shall comply with District and federal law and rules.

4111.5

All costs associated with the imposition of an alternative sanction against an ICF/IID pursuant to these rules shall be borne by the facility.

D.C. Mun. Regs. tit. 29, r. 29-4111

Final Rulemaking published at 60 DCR 11590 (August 9, 2013); as Amended by Final Rulemaking published at 61 DCR 12231 (November 28, 2014); amended by Final Rulemaking published at 63 DCR 297 (1/8/2016)

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 (2006 Repl. & 2012 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)) (2008 Repl.).