D.C. Mun. Regs. tit. 29, r. 29-718

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

Rule 29-718 - REIMBURSEMENT POLICY

718.1

A participating DTP shall have an established fee schedule covering each of the services it provides for which a charge is made.

718.2

Medicaid shall not reimburse providers for services given without charge.

718.3

A participating DTP shall agree to accept as payment, in full, the amount determined by the Department of Human Services as the fee for the authorized services provided to Medicaid patients.

718.4

No additional charge shall be made to the Medicaid patient, any member of the family, or to any other source.

718.5

A participating DTP shall agree to bill any and all other known third party payors prior to billing Medicaid.

718.6

A participating DTP shall not file any false claims, statements, documents, or conceal any factual material. Violations of the provisions of this subsection may be prosecuted under applicable federal and District laws.

718.7

Reimbursement shall be at a negotiated rate and shall not exceed the maximum allowable per diem rate established by the D.C. OHFC for all programs.

718.8

All claims submitted to DHCF for day treatment services rendered to any new admission admitted to a day treatment program as described in Sections 712 and 714 on or after January 1, 2013 shall be denied.

D.C. Mun. Regs. tit. 29, r. 29-718

Final Rulemaking published at 31 DCR 326 (January 27, 1984); as amended by Final Rulemaking published at 50 DCR 6702 (August 15, 2003); as amended by Final Rulemaking published at 55 DCR 8521 (August 8, 2008); as amended by Final Rulemaking published at 61 DCR 846 (January 31, 2014)

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. 774; 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.)).