3413.1 Each MHRS 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 issued by the District of Columbia Department of Consumer and Regulatory Affairs shall be evidence of qualification to conduct business.
3413.2 Each MHRS provider shall maintain the clinical operations policies and procedures described in this section, and which shall be reviewed and approved by the Department, during the certification survey process.
3413.3 Each MHRS provider shall:
(a) Have a governing authority, which shall have overall responsibility for the functioning of the MHRS provider;(b) Comply with all applicable Federal and District laws and regulations;(c) Hire personnel with the qualifications necessary to provide MHRS and to meet the needs of its enrolled consumers;(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.3413.4 Each MHRS provider shall establish and adhere to policies and procedures for selecting and hiring staff ("Staff Selection Policy"), which shall include:
(a) Evidence of each staff member's licensure, certification, or registration, as applicable and as required by the job being performed;(b) 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);(c) Evidence of all required criminal background checks, and for all non- licensed staff members, application of the criminal background check requirements contained in District Official Code §§ 44- 551et seq., Unlicensed Personnel Criminal Background Check, as well as quarterly child abuse registry checks for both state of residence and state of employment;(d) 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;(e) Evidence of completion of all communicable disease testing required by the Department and District laws and regulations;(f) A process by which all staff, as a condition of hiring, 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; and(g) Evidence that the provider conducts each required screening at the frequency required by District law and regulations, including quarterly exclusion checks and unlicensed employee criminal background checks every four (4) years.(h) Evidence of all required criminal background checks, and for all nonlicensed staff members, application of the criminal background check requirements contained in District Official Code §§ 44-551 et seq., Unlicensed Personnel Criminal Background Check, as well as yearly child abuse registry checks with state of residence and state of employment;3413.5 Each MHRS provider shall establish and adhere to written job descriptions for all positions, including, at a minimum, the role, responsibilities, reporting relationships, and minimum qualifications for each position. The minimum qualifications for each position shall be appropriate for the scope of responsibility and clinical practice described for each position.
3413.6 Each MHRS provider shall establish and adhere to policies and procedures requiring a periodic evaluation of clinical and administrative staff performance ("Performance Review Policy") that require an assessment of clinical competence and competence in behavioral health issues, as applicable, as well as general organizational work requirements, and an assessment of key functions as described in the job description. The periodic evaluation shall also include an annual individual development plan for each staff member.
3413.7 Each MHRS provider shall establish and adhere to policies and procedures to ensure that clinical staff are licensed, certified (if applicable), or registered (if applicable) and, to the extent required by applicable laws, regulations, work under the supervision of another qualified practitioner ("Supervision and Peer Review Policy"). The Supervision and Peer Review Policy shall:
(a) Include procedures for clinical supervision, which require sufficient clinical supervision conducted by qualified practitioners permitted to supervise per applicable District laws and regulations;(b) Require personnel files of non- licensed clinical staff and consumers' clinical records to contain evidence that the MHRS provider is observing the requirements of the Supervision and Peer Review Policy; and(c) Include an active peer review process to monitor quality of care delivered by qualified practitioners and credentialed staff.3413.8 Each MHRS provider shall establish and adhere to policies and procedures governing the credentialing or privileging of staff ("Credentialing Policy") consistent with the Department rules on privileging and competency-based credentialing systems. The Credentialing Policy shall:
(a) Allow staff who do not possess college degrees to be credentialed for direct service work, based on educational equivalent qualifications. These qualifications include experience that provides an individual with an understanding of mental illness, and which was acquired as an adult: (1) through personal experience with the mental health treatment system, or(2) through the provision of significant supports to adults with mental illness, or children and youth with mental health problems or with serious emotional disturbance;(b) Facilitate the employment of persons in recovery as peer counselors and members of community support teams; and(c) Include an assessment of qualified practitioners' cultural and linguistic competence.3413.9 Each MHRS provider shall have annual training that meets the federal Occupational Safety & Health Administration ("OSHA") regulations that govern behavioral health facilities and any other applicable infection control guidelines, including information on the use of universal precautions and on reducing exposure to hepatitis, tuberculosis, and HIV/AIDS.
3413.10 A provider shall have a current written plan for staff development and organizational on boarding, approved by the Department, which reflects the training and performance improvement needs of all employees working in that program. The plan shall address the steps the provider will take to ensure the recruitment and retention of highly qualified employees and the reinforcement of staff development through training, supervision, the performance management process, and activities such as shadowing, mentoring, skill testing, and coaching. The plan shall at a minimum include culturally competent training and on boarding activities in the following core areas:
(a) The provider's approach to addressing treatment or recovery services (as appropriate to certification), including philosophy, goals, and methods;(b) The staff member's specific job description and role in relationship to other staff;(c) Emergency preparedness plan and all safety-related policies and procedures;(d) The proper documentation of services in individual consumer records, as applicable;(e) Policies and procedures governing infection control, protection against exposure to communicable diseases, and the use of universal precautions;(f) Laws, regulations and policies governing confidentiality of consumer information and release of information;(g) Laws, regulations, and policies governing reporting abuse and neglect;(i) Other trainings, as deemed necessary by the Department.3413.11 Each MHRS provider shall establish and adhere to policies and procedures defining pre-admission, intake, screening, assessment, referral, transfer, and discharge procedures ("Admission, Transfer, and Discharge Policy") that comply with applicable Federal and District laws and regulations. The policies and procedures shall define the required documentation for screening or assessing consumers for admission to an EBP operated by the provider when the consumer's condition requires a modification in the Plan of Care.
3413.12 Each MHRS provider shall establish and adhere to policies and procedures governing the coordination of the treatment or recovery planning process ("Treatment Planning Policy or Recovery Planning Policy"), including procedures for designing, implementing, reviewing, and revising each consumer's Plan of Care that comply with the requirements of § 3411.
3413.13 Each MHRS provider shall establish and adhere to policies and procedures requiring that treatment be provided in accordance with the applicable service specific standards in this chapter ("Service Specific Policy"). The Service Specific Policy shall:
(a) Address supervision requirements and required caseload ratios that are appropriate to the population served and treatment modalities employed; and(b) Include a written description of the services offered by the MHRS provider ("Service Description") describing the purpose of the service, the hours of operation, the intended population to be served, recovery modalities provided by the service, treatment or recovery objectives, and expected outcomes.3413.14 Each MHRS provider shall establish and adhere to policies and procedures governing communication with the consumer's primary care providers ("Primary Care Provider Communication Policy"). The Primary Care Provider Communication Policy shall:
(a) Outline the MHRS provider's interface with primary health care providers, managed health care plans, and other providers of mental health services; and(b) Describe the MHRS provider's activities which will enhance consumer access to primary health care and the coordination of mental health and primary health care services.3413.15 Each MHRS provider shall establish and adhere to policies and procedures for handling routine, urgent, and emergency situations ("Unscheduled Service Access Policy"). The Unscheduled Service Access Policy shall:
(a) Include referral procedures to local emergency departments;(b) Include staff assignment to cover walk-in hours for urgent care;(c) Include arrangements for access to medication-somatic treatment practitioners and other clinical staff;(d) Describe the availability of telephone access to an independently licensed qualified practitioner, for the consumer, or other person acting on behalf of the consumer making contact with the MHRS provider;(e) Describe the availability of timely access to face-to-face crisis support services;(f) Describe how the MHRS provider will interact and coordinate services with the Department-designated crisis and emergency service; and(g) Include procedures for triaging consumers who require Crisis/Emergency services or psychiatric hospitalization.3413.16 Each MHRS provider shall establish and adhere to policies and procedures for clinical record documentation, security, and confidentiality of consumer and family information; clinical records retention, maintenance, purging and destruction; disclosure of consumer and family information; and informed consent that comply with applicable Federal and District laws and regulations ("Clinical Records Policy"). The Clinical Records Policy shall:
(a) Require the MHRS provider to maintain all clinical records in a secured and locked storage area;(b) Require that the MHRS provider utilize an electronic health records system to document all phases of the consumer's treatment and care. The MHRS provider shall comply with applicable Department policies on use and maintenance of an electronic health records system;(c) Require the MHRS provider to maintain all clinical records for a period of ten (10) years;(d) Require the MHRS provider to maintain and secure a current, clear, organized, and comprehensive clinical record for every individual assessed, treated, or served that includes information deemed necessary to provide treatment, protect the MHRS provider, and comply with applicable Federal and District laws and regulations; and(e) Require that the clinical record contain information to identify the consumer, support the diagnosis, justify the treatment, document the course and results of treatment, and facilitate continuity of care. The clinical record shall include, at a minimum: (1) Consumer identification information, including enrollment information;(2) Identification of a person to be contacted in the event of emergency;(3) Basic screening and intake information;(4) Documentation of internal or external referrals;(5) Comprehensive diagnostic and psychosocial assessments;(6) Pertinent medical information including the name, address, and telephone number of the consumer's primary care physician;(7) Advance instructions and advance directives;(9) For children and youth, documentation of family or legal guardian involvement in treatment planning and services or statement of reasons why it is not clinically indicated;(10) Methods for addressing consumers' and families' special needs, especially those which relate to communication, cultural, linguistic, and social factors;(11) Detailed description of services provided;(13) Discharge planning information;(14) Appropriate consents for service;(15) Appropriate release of information forms; and(16) Signed Consumer Rights Statement.(f) Electronic records shall include a log function that dates, times, and authenticates each entry, access, and change to a record.3413.17 Each MHRS provider shall participate in the District Health Information Exchange (HIE).
3413.18 Each MHRS provider shall comply with the Department's policy on supervision, including requirements for the documentation of supervision.
3413.19 Each MHRS provider shall enter encounter notes into the clinical record with sufficient written clinical documentation to support each therapy, service, activity, or session for which billing is made which, at a minimum, consists of:
(a) A dated, timed, and authenticated entry, entered by the person providing the service, which shall include the typed or legibly printed name of the author. The provider shall ensure all entries are authenticated by a process that verifies the author's identity (e.g., a unique log- in used only by the author);(b) The date and duration [actual time, a.m. or p.m. (beginning and ending)]during which the services were rendered;(c) The legal name, title, credentials, and signature of the person providing the services;(d) The setting in which the services were rendered;(e) The consumer's diagnosis and clinical impression recorded in the terminology of the ICD-10 CM (or any subsequent version adopted by the Department pursuant to written notice published in the District of Columbia Register);(f) Confirmation that the services delivered are contained in the consumer's Plan of Care;(g) A description of each service by a qualified practitioner or credentialed staff with the consumer that is sufficient to document that the service was provided in accordance with this chapter;(h) A description of the consumer's response to the service that is sufficient to show, particularly in the case of group interventions, the consumer's unique participation in the service; and(i) An easily accessible log identifying a complete history for each entry, including when the record was created, signed, and the time and dates of any subsequent access and amendments.3413.20 Each MHRS provider shall ensure that all clinical records of consumers are completed promptly, filed, and retained in accordance with the MHRS provider's Clinical Records Policy.
3413.21 All CSA, ACT, and CBI providers shall operate an on-call system for enrolled consumers that is available twenty-four (24) hours a day, seven (7) days a week. Providers shall make the following services available five (5) days per week from 9:00 am to 6:00 pm, in the evening by appointment, and at least once a month on a Saturday for four (4) hours: Diagnostic Assessment, Medication/Somatic treatment, Counseling, and Community Support.
3413.22Providers who deliver the following specialty services shall make their services available as follows:
MHRS SPECIALTY SERVICE | HOURS OF OPERATION | OTHER AVAILABILITY REQUIREMENTS |
Rehabilitation Day Services | Thirty (30) hours per week, no less than six (6) hours per day. | Consumers authorized and referred for service shall be admitted within seven (7) business days of the referral. |
Intensive Day Treatment | Seven (7) days per week, no less than five (5) hours per day. | Programs shall offer a minimum of thirty-five (35) hours of active programming per week. Consumers authorized and referred for Intensive Day Treatment shall be admitted within forty-eight (48) hours of referral. |
Community Based Intervention (CBI) | Levels I, II, and III -Twenty-four (24) hours per day, seven (7) days per week. | Consumers authorized and referred for all levels of CBI shall be admitted within forty-eight (48) hours of referral. A CBI Team member shall respond to a call from a family member or a significant other, either by telephone or face-to-face contact, within sixty (60) minutes of receiving the call. All CBI providers shall develop a crisis intervention plan for each consumer receiving CBI. |
Assertive Community Treatment (ACT) | Twenty-four (24) hours per day, seven (7) days per week, with emergency response coverage to include psychiatric availability. | Consumers authorized and referred for ACT shall be admitted within forty-eight (48) hours of referral. At least sixty percent (60%) of ACT services shall be provided in locations other than the office, according to consumer need, preference, and clinical appropriateness. An ACT team member shall respond to a call from family or a significant other, either by telephone or face-to-face contact within sixty (60) minutes of receiving the call. |
3413.23 Each MHRS provider shall establish and adhere to policies and procedures requiring the MHRS provider to make language access services available at no cost as needed for Limited or Non-English proficient consumers, ("Language Access Policy"). The Language Access Policy shall:
(a) Document primary language information in a consumer's clinical record at the point of entry, if known, with notations on how to engage the person in communication if unknown;(b) Arrange for the provision of language access services at no cost to Limited or Non-English proficient consumers;(c) Ensure public notices regarding language access services are posted in regularly encountered waiting rooms, reception areas, and other areas of initial contact.(d) Ensure that the public is aware of language interpretation services;(e) Provide a quarterly report on the number of enrolled consumers who receive language access services to the DBH Language Access Coordinator. The information shall include the following information: (1) The number of individuals who have Limited or Non-English proficiency, and the languages spoken;(2) The frequency with which Limited or Non-English proficient consumers come into contact with the provider;(3) The number and types of languages spoken by agency staff.(f) Provide annual training to all public access staff on how to provide ongoing language services; and(g) Ensure immediate notification of the DBH Language Access Coordinator when unable to meet language access needs.3413.24 The Language Access Policy shall allow staff and contractors who do not possess valid certification from the Registry of Interpreters for the Deaf to be credentialed based on skills in mental health interpreting gained through supervised experience. For purposes of this rule, supervised experience shall include supervision by an interpreter certified by the National Registry of Interpreters for the Deaf and ongoing training in sign language interpreting, preferably related to mental health, and may include on-the-job learning prior to employment by the MHRS provider.
3413.25 Each MHRS provider shall utilize a TTY communications line (or an equivalent) to enhance the MHRS provider's ability to respond to service requests and needs of consumers and potential consumers. MHRS provider staff shall be trained in the use of such communication devices as part of the annual language access training.
3413.26 Each MHRS provider shall establish and adhere to policies and procedures which govern the provision of services in natural settings ("Natural Settings Policy"). The Natural Settings Policy shall require the MHRS provider to document how it respects consumers' and families' rights to privacy and confidentiality when services are provided in natural settings.
3413.27 Each MHRS provider shall establish and adhere to anti-discrimination policies and procedures relative to hiring, promotion, and provision of services to consumers that comply with applicable Federal and District laws and regulations ("Anti- Discrimination Policy").
3413.28 Each MHRS provider shall establish a quality improvement program ("QI program") and adhere to policies and procedures governing quality improvement ("Quality Improvement Policy"). The Quality Improvement Policy shall require the MHRS provider to adopt a written Quality Improvement ("QI") plan describing the objectives and scope of its QI program and requiring MHRS provider staff, consumer, and family involvement in the QI program. The Department shall review and approve each MHRS provider's QI program at a minimum as part of the certification process. The QI program shall submit data to the Department, upon request. The QI program shall be:
(a) Directed by a coordinator ("QI Coordinator") who has direct access to the Chief Executive Officer or Program Director, if applicable. In addition to directing the QI program's activities, the QI Coordinator shall also review unusual incidents, deaths, and other sentinel events; monitor and review utilization patterns; and track consumer complaints and grievances. The QI Coordinator shall be: (1) An individual licensed as one of the following practitioner types: Psychiatrist, Psychologist, Licensed Independent Clinical Social Worker ("LICSW"), Advanced Practice Registered Nurse ("APRN"), Licensed Professional Counselor ("LPC"), Licensed Marriage and Family Therapist ("LMFT"), Registered Nurse ("RN "), Licensed Independent Social Worker ("LISW"), Licensed Graduate Professional Counselors ("LGPC"), Licensed Graduate Social Worker("LGSW"), or Physician Assistant; or registered as a Psychology Associate; or(2) An individual with a Bachelors' Degree and a minimum of two (2) years of relevant, qualifying experience, such as experience in behavioral health care delivery or health care quality improvement initiatives.(b) The QI program shall measure and ensure at least the following: (1) Timely access to and availability of services;(2) Adequacy, appropriateness, and quality of care, including treatment and prevention of acute and chronic conditions;(3) Close monitoring of high- volume services, consumers with high risk conditions, and services for children and youth;(4) Coordination of care among behavioral health treatment providers, and between behavioral health providers and primary and other specialty care providers;(5) Compliance with all MHRS certification standards;(6) Consumer and family satisfaction with services; and(7) Any other indicators that are part of the Department QI program for the larger system.3413.29 Each MHRS provider shall comply with the following requirements for facilities management:
(a) Each service site of an MHRS provider shall be an adequate and appropriate facility with: (2) Consumer interview rooms for private, confidential individual and group counseling sessions and private areas for other individual treatment services;(3) Appropriate space for group activities and educational programs; and(4) Restrooms available to consumers and their families and significant others.(b) All areas of the MHRS provider's service site(s) shall be kept clean and safe, and shall be appropriately equipped and furnished for the services delivered.(c) In-office waiting time shall be less than one (1) hour from the scheduled appointment time. Each MHRS provider shall demonstrate that it can document the time period for in-office waiting.(d) Each MHRS provider shall comply with applicable provisions of the Americans with Disabilities Act in all business locations.(e) Each MHRS provider's main service site shall be located within reasonable walking distance of public transportation.(f) Each MHRS provider shall establish and adhere to a written evacuation plan to be used in fire, natural disaster, medical emergencies, bomb threats, terrorist attacks, violence in the workplace, or other disaster events for all service sites ("Disaster Evacuation Plan").(g) The Disaster Evacuation Plan shall require the MHRS provider:(1) To conduct periodic disaster evacuation drills;(2) Ensure that all evacuation routes are clearly marked by lighted exit signs; and(3) Ensure that all staff participate in annual training about the Disaster Evacuation Plan and disaster response procedures.(h) Each MHRS provider shall obtain a written certificate of compliance from the District of Columbia Department of Fire and Emergency Medical Services indicating that all applicable fire and safety code requirements have been satisfied.(i) Each MHRS provider shall provide physical facilities for all service site(s) that are structurally sound and meet all applicable Federal and District laws and regulations for construction, safety, sanitation, and health.(j) Each MHRS provider shall establish and adhere to policies and procedures governing infection control ("Infection Control Policy"). The Infection Control Policy shall comply with applicable Federal and District laws and regulations, including, but not limited to the blood borne pathogens standard set forth in 29 CFR § 1910.1030.(k) Each MHRS provider shall establish and adhere to policies and procedures governing the purchase, receipt, storage, distribution, return, and destruction of medication that include accountability for and security of medications located at any of its service sites ("Medication Policy"). The Medication Policy shall comply with applicable Federal and District laws and regulations regarding the purchase, receipt, storage, distribution, dispensing, return, and destruction of medications and require the MHRS provider to maintain all medications and prescription blanks in a secured and locked area.3413.30 Each MHRS 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 MHRS provider and the scope of such decision- making authority. Each MHRS 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 MHRS 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.3413.31 Each MHRS provider shall establish and adhere to policies and procedures governing the retention, maintenance, purging and destruction of its business records ("Records Retention Policy"). The Records Retention Policy shall:
(a) Comply with applicable Federal and District laws and regulations;(b) Require the MHRS provider to maintain all business records pertaining to costs, payments received and made, and services provided to consumers for a period of ten (10) years or until all audits are completed, whichever is longer; and(c) Require the MHRS provider to allow the Department, DHCF, the District's Inspector General, the United States Department of Health and Human Services, the Comptroller General of the United States, or any of their authorized representatives to review the MHRS provider's business records, including clinical and financial records.3413.32 Each MHRS provider shall comply with the following requirements for maintaining certification, provider status, and contracts:
(a) Maintain proof of the Department certification;(b) Maintain an active Medicaid provider status at all times;(c) Maintain copies of contracts with the Department, vendors, suppliers, and independent contractors; and(d) Require that its subcontractors continuously comply with the provisions of the MHRS provider's HCA with the Department.3413.33 Each MHRS 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.3413.34 Each MHRS provider shall establish and adhere to policies and procedures governing billing and payment for MHRS ("Billing and Payment Policy"). The Billing and Payment Policy shall require the MHRS provider to have the necessary operational capacity to submit claims, 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 MHRS provided by MHRS provider staff and subcontractors;(c) Submit claims and documentation of MHRS on a timely basis with applicable DBH and DHCF requirements; and(d) Track payments for all provided MHRS.3413.35 Each MHRS provider shall submit claims for MHRS provided to consumers described in § 3407.2 to the Department within ninety (90) calendar days of the date of service, or thirty (30) calendar days after a secondary or third-party payer has adjudicated a claim for this service. The Department shall not pay for a claim that is submitted more than one (1) year from the date of service, except when Federal law or regulations would require such payment to be made.
3413.36 Each MHRS provider shall have an established sliding fee schedule covering each of the MHRS it provides. For services provided to Medicaid-eligible consumers, no additional charge shall be imposed for services beyond that paid by Medicaid.
3413.37 Each MHRS provider shall utilize, and require its subcontractors to utilize, payments from other public or private sources, including Medicare. Payment of the Department and Federal funds to the MHRS provider shall be conditional upon the utilization of all benefits from other payment sources.
3413.38 Each MHRS 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 MHRS 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 MHRS provider. Each MHRS 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 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 the Center for Medicare and Medicaid Services ("CMS"), the provider shall notify the Department immediately.3413.39 Each MHRS provider shall establish and adhere to a plan for ensuring compliance with applicable Federal and District laws and regulations ("Corporate Compliance Plan"), approved by the Department. Each MHRS provider shall submit any updates or modifications to its Corporate Compliance Plan to the Department for prior review and approval. Each MHRS provider's Corporate Compliance Plan shall:
(a) Designate an officer or director with responsibility and authority to implement and oversee the operation of the Corporate Compliance Plan;(b) Require that all officers, directors, managers, and employees sign a statement that they understand the Corporate Compliance Plan;(c) Include procedures designed to prevent and detect potential or suspected fraud, waste, or abuse in the administration and delivery of MHRS;(d) Include procedures for the confidential reporting of violations of the Corporate Compliance Plan to the Department, including procedures for the investigation and follow- up of any reported violations;(e) Ensure that the identities of individuals reporting suspected violations of the Corporate Compliance Plan are protected and that individuals reporting suspected violations, fraud, waste, or abuse are not retaliated against;(f) Require that confirmed violations of the Corporate Compliance Plan be reported to the Department within twenty-four (24) hours of confirmation; and(g) Require any confirmed or suspected fraud, waste, or abuse under state or Federal laws or regulations be reported to the Department.3413.40 Each MHRS 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.
3413.41 Each MHRS provider shall have the capability to submit accurate claims, encounter data, and other submissions as necessary directly to the Department.
3413.42 Claims for MHRS provided to consumers described in § 3407.2 shall be submitted using the format required by the Department.
3413.43 Each MHRS provider shall manage protected health information in compliance with the confidentiality requirements contained in applicable Federal and District laws and regulations, including Health Insurance Portability and Accountability Act (HIPAA) and the D.C. Mental Health Information Act. The provider shall develop and implement policies and procedures to disclose protected behavioral health information to other certified providers, primary health care providers, and other health care organizations when necessary to coordinate the care and treatment of its consumers. These procedures shall include entering into an agreement with the District HIE, unless exempted pursuant to § 3402.1. The program shall advise each consumer of the program's notice of privacy practices that authorizes the disclosure to other providers and shall afford the consumer the opportunity to opt-out of that disclosure in accord with the District of Columbia Mental Health Information Act, D.C. Official Code § 7-1203.01. The program shall document the individual's decision.
3413.44 Each MHRS provider shall establish and adhere to a plan that contains policies and procedures for maintaining the security of data and information ("Disaster Recovery Plan"). Each MHRS provider's Disaster Recovery Plan shall also stipulate back- up and redundant systems and measures that are designed to prevent the loss of data and information and to enable the recovery of data and information lost due to disastrous events.
D.C. Mun. Regs. r. 22-A3413
Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); as amended by Notice of Final Rulemaking published at 58 DCR 8366, 8369 (September 30, 2011); amended by Final Rulemaking published at 67 DCR 10674 (9/4/2020); amended by Final Rulemaking published at 68 DCR 012400 (11/26/2021); amended by Final Rulemaking published at 70 DCR 3050 (3/10/2023), effective date corrected to 4/7/2023, by Errata Notice published at 71 DCR 4474 (4/19/2024).Authority: The Director of the Department of Mental Health (Department), pursuant to the authority set forth in sections 104, and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05 (2008 Repl.)).