D.C. Mun. Regs. r. 22-A8004

Current through Register Vol. 71, No. 25, June 21, 2024

Rule 22-A8004 - DENIAL OR DECERTIFICATION PROCESS

8004.1

The Director may deny initial certification if the applicant fails to comply with any certification standard or the application fails to demonstrate the applicant's capacity to deliver high quality behavioral health stabilization services on a sustained and regular basis. Furthermore, to avoid an over concentration of providers in areas with existing providers and to encourage increased access to underserved areas of the District, the Director may deny certification if the applicant proposes to operate a facility in an area already served by one (1) or more providers. The Department's priority shall be to grant certification to applicants that will address unmet needs of the behavioral health system. While applicants may make minor corrections and substitutions to its application during the certification process, evidence of one (1) or more of the following shall constitute good cause to deny the application for certification when the circumstances demonstrate deliberate misrepresentations, organizational instability, or the lack of preparedness or capacity to meet and sustain compliance with this chapter:

(a) An incomplete application;

(b) False information provided by applicant or contained in an application;

(c) One (1) or more changes to an organizational chart during the application process;

(d) A facility that is inadequate in health, safety, size or configuration to provide services consistent with high quality care and privacy standards;

(e) The lack of demonstrated experience providing behavioral health stabilization services by the applicant's clinical leadership, practitioners, or staff;

(f) An applicant's failure to timely respond to the Department's request for information;

(g) History of poor performance; and

(h) History of poor performance.

(i) Lack of behavioral health accreditation in accordance with § 8031.1.

8004.2

Upon written request submitted by the applicant and received by the Department within fifteen (15) business days of the certification denial, the Department shall provide an applicant an impartial administrative review of the decision. The Department shall conduct the administrative review to determine whether the certification denial complied with § 8004.1. Each request for an administrative review shall contain a concise statement of the reason(s) why the certification denial was in error. The Director shall issue a written decision within fifteen (15) business days. The Director's decision is final and not subject to further appeal. An applicant and its principals shall not be allowed to reapply for certification for twelve (12) months following the date of denial.

8004.3

An applicant and its executive leadership shall not be allowed to reapply for certification for twelve (12) months following the date of the initial denial or, if applicable, the date of the denial pursuant to the Director's administrative review.

8004.4

The Department shall decertify existing providers who fail to comply with the certification requirements contained in this chapter. Evidence of one (1) or more of the following shall constitute good cause to decertify:

(a) An incomplete recertification application;

(b) False information provided by provider or contained in a recertification application;

(c) High staff turnover where there are two or more changes made to the leadership staff within a certification period, demonstrating organizational instability;

(d) One (1) or more documented violations of the certification standards during the certification period that evidence a provider's lack of capacity to meet and sustain compliance with this chapter;

(e) Claims audit error rate in excess of twenty-five percent (25%);

(f) A provider's lack of financial resources to carry out its commitments and obligations under this chapter for the foreseeable future, evidenced by an inability to all pay staff, or an inability to provide at least ninety (90) calendar days of running capital as dictated by the provider monthly operating budget;

(g) Failure to cooperate with Department investigations or lack of timely response to information requests; or

(h) Failure to obtain or maintain in good standing national accreditation in accordance with § 8031.1 or meet the timelines in § 8031.2.

8004.5

Nothing in this chapter requires the Director to issue a SOD or a Notice of Infraction ("NOI") prior to decertifying a provider. If the Director finds that there are grounds for decertification, the Director shall issue a written notice of decertification setting forth the factual basis for the decertification, the effective date, and the provider's right to request an administrative review.

8004.6

The provider may request an administrative review from the Director within fifteen (15) business days of the date on the notice of decertification.

8004.7

Each request for an administrative review shall contain a concise statement of the reason(s) why the provider asserts that it should not have had its certification revoked and include any relevant supporting documentation.

8004.8

Each administrative review shall be conducted by the Director and shall be completed within fifteen (15) business days of the receipt of the provider's request.

8004.9

The Director shall issue a written decision and provide a copy to the provider. If the Director denies the appeal and approves the decertification, the provider may request a hearing under the D.C. Administrative Procedure Act, within fifteen (15) business days of the receipt of the Director's written decision. The administrative hearing shall be limited to the issues raised in the administrative review request. The decertification shall be stayed pending resolution of the hearing.

8004.10

Upon decertification, the provider and its executive leadership shall not be allowed to reapply for certification for a period of two (2) years following the date of the order of revocation. If a provider reapplies for certification, the provider must reapply in accordance with the established certification standards for the type of services provided and show evidence that the grounds for the revocation have been corrected.

D.C. Mun. Regs. r. 22-A8004

Final Rulemaking published at 68 DCR 1623 (2/5/2021); amended by amended by Final Rulemaking published at 70 DCR 3050 (3/10/2023)