D.C. Mun. Regs. tit. 29 § 1307

Current through Register Vol. 71, No. 19, May 10, 2024
Rule 29-1307 - SUSPENSION OF MEDICAID PAYMENTS FOR OVERPAYMENT-EVIDENCE AND NOTICE
1307.1

When the provider, pursuant to § 1306, submits a statement, the Director shall consider the statement including any pertinent evidence submitted together with any other material bearing upon the case and shall make a determination as to whether the facts justify a suspension.

1307.2

If the Director determines that a suspension shall go into effect, a written notice of the detemination shall be sent to the provider.

1307.3

The notice shall contain specific findings on the conditions upon which the suspension was based and an explanatory statement for the final decision.

1307.4

The suspension shall not take effect for at least fifteen (15) days following the date of the notice.

1307.5

If the provider requests a hearing by filing a notice of appeal from the determination of suspension and overpayment with the D.C. Board of Appeals and Review within the fifteen (15) day period, the suspension shall not take effect until after a final decision is rendered following a hearing under these rules.

1307.6

A request for a hearing to appeal the Director's decision to suspend shall not stay the effectiveness of the suspension, if the Director determines that there is reasonable cause to believe that the provider will not refund overpayments other than through offset of program payments by suspension.

1307.7

The Director's implemention of a suspension, in whole or in part, does not in any way abrogate the right of the provider to file an appeal with the D.C. Board of Appeals and Review and to have a final decision rendered before final liability is established.

1307.8

The provider has fifteen (15) days from the date of the notice sent, pursuant to § 1307.4, to request a hearing by filing a notice of appeal.

D.C. Mun. Regs. Tit. 29, § 1307

Final Rulemaking published at 31 DCR 3870 (August 3, 1984)