D.C. Mun. Regs. tit. 22, r. 22-B4412

Current through Register Vol. 71, No. 50, December 13, 2024

Rule 22-B4412 - INVESTIGATION AND CERTIFICATION OF COMPLIANCE

4412.1

Any person may file a complaint with the Director that a CON holder is not complying with the requirements of this chapter.

4412.2

Each complaint shall include the following information:

(a) The name and address of the complainant;

(b) The name and address of the CON holder;

(c) The date or approximate date on which the event or incident being complained of occurred; and

(d) A statement describing the event or incident that the complainant believes violates the requirements of this chapter.

4412.3

The filing date of a complaint shall be the date of receipt by the SHPDA.

4412.4

The Director shall provide a copy of the complaint to the CON holder named in the complaint within ten (10) business days after receiving the complaint.

4412.5

The Director shall initiate an investigation of each complaint filed pursuant to the provisions of this section within thirty (30) business days of its receipt.

4412.6

The CON holder shall provide the Director with documents, records, or other requested information that may assist in investigating the complaint.

4412.7

A CON holder shall be out of compliance with its uncompensated care obligations if it fails to provide documentation the Director requests to determine the CON holder's compliance with this chapter.

4412.8

The Director shall determine the merit of a complaint based on:

(a) Information contained in the complaint;

(b) Documents the CON holder provides; and

(c) Other credible information the Director receives.

4412.9

If the Director determines that a complaint is not substantiated, the Director shall dismiss the complaint.

4412.10

The Director shall make periodic reviews of the uncompensated care requirements and activities of each CON holder to determine whether a CON holder is complying with its obligations.

4412.11

The Director shall conduct audits to determine each CON holder's compliance with its uncompensated care obligation according to standard audit procedures.

4412.12

After completing the audit the Director may certify that a CON holder has substantially complied with its uncompensated care obligation for a specific fiscal year or years. The certification shall confirm that the CON holder has provided the uncompensated care stated for the period covered by the certification.

4412.13

The Director shall base each certification of substantial compliance on the amount of uncompensated care properly claimed by the CON holder, using procedures and reviewing individual account data the Director determines to be sufficient to establish that the CON holder has substantially complied with its uncompensated care obligation for the period covered by the certification.

4412.14

The Director may certify substantial compliance when he or she determines that, for the period covered by the certification, the CON holder provided uncompensated care to eligible persons who had equal opportunity to apply for uncompensated care.

4412.15

To determine whether a CON holder has substantially complied with its obligations, the SHPDA shall consider each of the following in descending order of importance:

(a) Whether the CON holder took corrective action prescribed pursuant to § 4413;

(b) Whether the CON holder's noncompliance with its uncompensated care obligation may be remedied by corrective action under § 4413; and

(c) Whether the CON holder had procedures in place that complied with the applicable notice, eligibility, and record keeping requirements of §§ 4405, 4406, 4408, 4410, and 4411, and systematically and correctly followed the procedures.

4412.16

The Director shall determine and certify the amount of creditable service required by each CON holder for the three (3) fiscal years ending prior to the effective date of these rules. The Director shall base the determination on information necessary to establish the CON holder's substantial compliance with its uncompensated care obligation during the period being reviewed.

4412.17

To determine creditable service during the three (3) fiscal years ending prior to the effective date of these rules, each CON holder shall submit to the Director for each fiscal year the following:

(a) The number of persons to whom it provided care without charge or below its normal and customary charge;

(b) The total dollar amount of uncompensated care it provided in each fiscal year and the method used to determine that dollar amount; and

(c) A description of the eligibility criteria it used for providing uncompensated care.

D.C. Mun. Regs. tit. 22, r. 22-B4412

Final Rulemaking published at 36 DCR 5819 (August 11, 1989); as amended by Final Rulemaking published at 52 DCR 8258 (September 2, 2005); as amended by Final Rulemaking published at 53 DCR 4808 (June 16, 2006)

Authority: This chapter was originally enacted under the authority of the District of Columbia Certificate of Need Act of 1980, effective September 16, 1980 (D.C. Law 3-99; D.C. Official Code, §§ 44-1801 to 44-1817 (2001 ed.)), and amended by the District of Columbia Certificate of Need Act of 1980 Amendment Act of 1987, effective March 16, 1988 (D.C. Law 7-90; 35 DCR 710 (February 5, 1988)). Subsequent to the enactment of this chapter, the District of Columbia Certificate of Need Act of 1980 was repealed by § 22 of the Health Services Planning Program Act of 1992, effective March 16, 1993 (D.C. Law 9-197; 39 DCR 9195 (December 11, 1992)). Later authority for the regulation of Certificates of Need was found at D.C. Official Code §§ 44-401 to 44-421 (2001 ed.); Mayor's Reorganization Plan No. 3 of 1986; and Mayor's Order 95-162, dated December 4, 1995.