D.C. Mun. Regs. tit. 29, r. 29-8904

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

Rule 29-8904 - APPEALS

8904.1

A provider may appeal any of the following issues:

(a) Incentive payment amounts;

(b) Provider eligibility determinations; and

(c) Demonstration of adopting, implementing, upgrading, and meaningful use of technology.

8904.2

DHCF shall issue a written determination to a provider if it finds the following:

(a) The initial MEIP amount will not be issued because the calculation is incorrect;

(b) The initial MEIP amount will not be issued because the provider has an outstanding balance due which was offset against the MEIP payment;

(c) Failure to meet MEIP eligibility requirements;

(d) Failure to meet the meaningful use requirements; or

(e) Failure to provide sufficient documentation to support adopting, implementing, or upgrading a certified electronic health record.

8904.3

The written determination described in Subsection 8904.2 shall include the following:

(a) A finding as described in Subsection 8904.2 that includes a description of why the criteria were not met;

(b) The policy, rule, or statute upon which the determination was made; and

(c) An explanation of the right to request an administrative review as well as the timeframes for a request.

8904.4

Within thirty (30) calendar days of receipt of the written determination set forth in Subsections 8904.2 and 8904.3, a provider that disagrees with the determination shall have the right to request an administrative review with DHCF. The written request for administrative review shall include the reason for the request, the relief requested and documentation in support of the relief requested.

8904.5

DHCF shall issue a formal written determination relative to the administrative review no later than sixty (60) calendar days after receipt of the provider's written request for administrative review.

8904.6

Within thirty (30) calendar days after receipt of DHCF's written response to the administrative review, the provider may appeal the decision by filing a written notice of appeal with the D.C. Office of Administrative Hearings.

D.C. Mun. Regs. tit. 29, r. 29-8904

Final Rulemaking published at 61 DCR 237 (January 10, 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.744; D.C. Official Code § 1-307.02 (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.)).