D.C. Mun. Regs. tit. 29, r. 29-7414

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

Rule 29-7414 - HSS PROVIDER QUALIFICATIONS

7414.1

The HSS provider shall be established as a legally recognized entity in the District of Columbia and qualified to conduct business in the District. A certificate of good standing and valid basic business license, both issued by the District of Columbia Department of Consumer and Regulatory Affairs, shall be evidence of qualification to conduct business.

7414.2

The HSS provider shall:

(a) Have a governing body with oversight responsibility for administrative and programmatic policy development, monitoring and implementation;

(b) Comply with all applicable Federal and District laws and regulations;

(c) Hire personnel with the qualifications necessary to provide HSS and to meet the needs of its enrolled consumers, as described at § 7411;

(d) Ensure that independently licensed qualified practitioners are available to provide appropriate and adequate supervision of all clinical activities; and

(e) Employ qualified practitioners that meet all professional requirements as defined by the applicable licensing, certification, and registration laws and regulations of the District or the jurisdiction where services are delivered.

7414.3

The HSS provider shall comply with the cost survey and program integrity audits set forth in Chapter 103 of Title 29 DCMR.

7414.4

The HSS provider shall obtain background check documents for all persons employed by the HSS provider, including subcontracted staff or any volunteers with direct contact with program individuals, and submit these documents to the Department.

7414.5

Background check documents for all HSS provider personnel must be current, within two (2) years of submission date, and include:

(a) A current government issued photo Identification (ID) (e.g., driver's license, state issued ID, or passport);

(b) Evidence of each staff member's licensure, certification, or registration, as applicable and as required by the job being performed;

(c) For non-licensed staff, evidence of completion of an appropriate degree, appropriate training program, or appropriate credentials (e.g., an academic transcript or a copy of degree);

(d) Evidence of all required criminal background checks, and for all staff members, application of the criminal background check requirements contained in the HSS provider's HCA with the Department;

(e) Evidence of quarterly checks that no individual is excluded from participation in a federally funded health care program as listed on the Department of Health and Human Services' "List of Excluded Individuals/Entities," the General Services Administration's "Excluded Parties List System," or any similar succeeding governmental list; and

(f) Evidence of completion of all communicable disease testing required by the Department and District laws and regulations.

7414.6

The HSS provider shall conduct each required screening for all staff at the frequency required by District law and regulations or by the Department, whichever is most stringent.

7414.7

The Department must clear each person employed by the HSS provider, including subcontracted staff or any volunteers with direct contact with program individuals, for fitness before beginning work or having contact with individuals.

7414.8

The HSS provider shall ensure that any applicant for a compensated position and candidates for unsupervised volunteer positions complete the required criminal background screening before any such applicant or candidate may be offered a compensated position or an unsupervised volunteer position with the HSS Provider.

7414.9

The HSS provider must provide the Department the process by which an applicant for employment, including subcontractors or any volunteers with direct contact with program individuals, shall declare any present or past events that might raise liability or risk management concerns, such as malpractice actions, insurance cancellations, criminal convictions, Medicare/Medicaid sanctions, and ethical violations.

7414.10

The HSS provider shall ensure all employees are not adversely affected by alcohol, illegal drugs, or legal drug use during work hours. The HSS provider shall have an active drug-free workplace policy and shall utilize drug testing to ensure that each job applicant, employee, and unsupervised volunteer are not under the influence of drugs or alcohol while working with program individuals.

7414.11

The HSS provider shall complete a suitability screening for each employee as outlined in its HCA with the Department.

7414.12

The HSS provider shall establish and adhere to policies and procedures responding to individual grievances and incorporate this information into its HSS Program Rules as described in Section 18 of the Act.

7414.13

The HSS provider shall establish uniform procedures for employees to file grievances, in writing, to the provider (including requests for case manager reassignments) and shall post these procedures in applicable paperwork, administrative offices, and in the facilities used to provide services. The procedures for filing grievances shall be a part of the provider's employee handbook shall be approved by the District.

7414.14

The HSS provider shall have a written plan for staff development and organizational onboarding, approved by the Department, which reflects the training and performance improvement needs of all employees working in that program.

7414.15

The HSS provider shall establish and adhere to policies and procedures for record documentation, security, and confidentiality of individual and family information; clinical records retention, maintenance, purging and destruction; disclosure of individual and family information; and informed consent that comply with applicable Federal and District laws and regulations.

7414.16

The HSS provider shall have the necessary operational capacity to submit claims for Medicaid-reimbursable HSS and invoices for locally-reimbursed PSH services, document information on services provided, and track payments received. This operational capacity shall include the ability to:

(a) Verify eligibility for Medicaid and other third-party payers;

(b) Document HSS provided by Department-certified HSS provider staff and sub-provider;

(c) Submit claims and invoices, and relevant documentation of HSS on a timely basis in compliance with applicable requirements of the Department and DHCF; and

(d) Track payments for all provided HSS.

7414.17

The HSS provider shall comply with requirements of the District of Columbia Language Access Act of 2004, as amended, D.C. Official Code § 2-1931, et seq.

7414.18

The HSS provider shall also comply with requirements listed in Section 1557 of the Patient Protection and Affordable Care Act, as amended, 42 U.S.C. § 18116(a).

7414.19

The HSS provider shall comply with applicable provisions of the Americans with Disabilities Act of 1990, 42 U.S.C. § 12101, et seq., in all business locations.

7414.20

The HSS provider shall utilize a TeleTYpe (TTY) telecommunications line (or an equivalent) to enhance the HSS provider's ability to respond to service requests and needs of individuals and potential individuals. HSS provider staff shall be trained in the use of such communication devices as part of the annual language access training.

7414.21

The HSS provider shall establish and adhere to anti-discrimination policies and procedures relative to hiring, promotion, and provision of services to individuals that comply with applicable Federal and District laws and regulations (AntiDiscrimination Policy).

7414.22

The HSS provider shall have established by-laws or other legal documentation regulating the conduct of its internal financial affairs. This documentation shall clearly identify the individual(s) that are legally responsible for making financial decisions for the HSS provider and the scope of such decision-making authority. The HSS provider shall:

(a) Maintain an accounting system that conforms to generally accepted accounting principles, provides for adequate internal controls, permits the development of an annual budget, an audit of all income received, and an audit of all expenditures disbursed by the HSS provider in the provision of services;

(b) Have an internal process for the development of interim and annual financial statements that compares actual income and expenditures with budgeted amounts, accounts receivable, and accounts payable information; and

(c) Operate in accordance with an annual budget established by its governing authority.

7414.23

The HSS provider shall establish and adhere to policies and procedures governing the retention, maintenance, purging and destruction of its business records, that:

(a) Comply with applicable Federal and District laws and regulations;

(b) Require the HSS provider to maintain all business records pertaining to costs, payments received and made, and services provided to individuals for a period of ten (10) years or until all audits are completed, whichever is longer; and

(c) Require the HSS provider to allow the Department, DHCF, the District's Inspector General, HHS, the Comptroller General of the United States, or any of their authorized representatives to review the HSS provider's business records, including client clinical and financial records.

7414.24

The HSS provider, at its expense, shall:

(a) Obtain at least the minimum insurance coverage required by its HCA; and

(b) Make evidence of its insurance coverage available to the Department upon request.

7414.25

The HSS provider shall operate according to all applicable Federal and District laws and regulations relating to fraud, waste, and abuse in health care, the provision of mental health services, and the Medicaid program. An HSS provider's failure to report potential or suspected fraud, waste or abuse may result in sanctions, cancellation of contract, or exclusion from participation as an HSS provider. The HSS provider shall:

(a) Cooperate and assist any District or Federal agency charged with the duty of identifying, investigating, or prosecuting suspected fraud, waste, or abuse;

(b) Provide the Department with regular access to the HSS provider's medical and billing records, including electronic medical records, within twenty-four (24) hours of a Departmental request, or immediately in the case of emergency;

(c) Be responsible for promptly reporting suspected fraud, waste, or abuse to the Department, taking prompt corrective actions consistent with the terms of any contract or subcontract with the Department, and cooperating with DHCF or other governmental investigations; and

(d) Ensure that none of its practitioners have been excluded from participation as a Medicaid or Medicare provider. If a practitioner is determined to be excluded by CMS, the HSS provider shall notify the Department immediately.

7414.26

The HSS provider shall ensure that sufficient resources (e.g., personnel, hardware, or software) are available to support the operations of computerized systems for collection, analysis, and reporting of information, along with claims submission.

7414.27

The HSS provider shall have the capability to submit accurate claims, number of engagement with each individual on a monthly basis, and other submissions as necessary directly to the Department.

7414.28

The HSS provider does not normally need an individual's detailed health information, such as diagnosis or specific services received, or full access to medical records (particularly for behavioral health conditions or sensitive information like HIV status). However, the HSS provider shall have a clearly defined protocol to prevent inappropriate information sharing that might violate the Health Insurance and Portability and Accountability Act of 1996 (P.L. 104191), as amended (HIPAA) or Section 543 of the Public Health Service Act (P.L. 102-321).

D.C. Mun. Regs. tit. 29, r. 29-7414

Final Rulemaking published at 71 DCR 6868 (6/7/2024)