D.C. Mun. Regs. tit. 29, r. 29-8711

Current through Register 71, No. 45, November 7, 2024

Rule 29-8711 - OVERSIGHT AND ENFORCEMENT

8711.1

DHCF shall take enforcement actions as necessary, including the suspension or revocation of registration or designation in accordance with the requirements set forth below:

(a) When DHCF is considering suspension or revocation of an HIE entity's registration or designation as set forth in this section, all investigatory data that are collected, created, or maintained related to the suspension or revocation are classified as confidential data on persons and as protected nonpublic data; and

(b) DHCF may disclose data classified as protected nonpublic or confidential under § 8711.1 (a) if disclosing the data, as permissible under 45 CFR § 164.512(j), will protect the health, privacy, or safety of health care consumers.

8711.2

DHCF may take action as necessary to address violations of this chapter by requiring corrective action or suspending or revoking an HIE entity's registration or designation. DHCF shall notify the HIE entity in writing stating the grounds for the action taken. Notice shall include:

(a) A reference to the regulatory or statutory authority, including policy and program manuals, for the action;

(b) A description of the findings of fact regarding the violations with respect to which the action is proposed;

(c) The nature of the action;

(d) Any circumstances that were considered in determining the amount of the proposed action;

(e) Instructions for responding to the notice, including a statement of the HIE entity's ability to request administrative review; and

(f) The address to which the request for review must be sent.

8711.3

If DHCF suspends or revokes the registration or designation of a HIE entity, the HIE entity shall not, during the period of suspension or revocation, engage in any new advertising or solicitation or hold itself out as a registered or designated HIE entity.

8711.4

All suspensions of registration or designation shall be accompanied by a requirement for corrective action.

8711.5

A DHCF written request for corrective action shall include:

(a) Nature and scope of corrective action requested;

(b) Date by which corrective action must be completed by the registered or designated HIE entity; and

(c) Details on how DHCF will evaluate the registered or designated HIE entity's correction of underlying issues.

8711.6

DHCF may suspend or revoke a registration or designation issued to an HIE entity or issue a requirement for corrective action if the DHCF finds that:

(a) The HIE entity is operating outside of nationally recognized standards identified by DHCF in policy guidance, or in a manner contrary to that described in any other information submitted under §§ 8702.2 and 8708.5, unless amendments to the submissions have been filed with and approved by DHCF;

(b) The HIE entity is unable to fulfill its obligations to furnish comprehensive HIE services as required under its agreement s with DHCF or with its participating organizations;

(c) The HIE entity is no longer financially solvent or is not reasonably expected to meet its obligations to DHCF or its participating organizations;

(d) The HIE entity, or any person acting with its sanction, has advertised or merchandised its services in an untrue, misleading, deceptive, or unfair manner;

(e) The continued operation of the HIE would pose risks to its participating organizations or the privacy and security of health care consumers served by the participating organizations;

(f) The HIE entity improperly discloses any PHI, or health information derived from PHI, that is available through the registered or designated HIE entity's infrastructure, except as consistent with or otherwise permitted by this chapter and applicable federal or District law; and

(g) The HIE entity has otherwise failed to substantially comply with the requirements of this chapter or other applicable federal or District law.

8711.7 Within thirty (30) calendar days of receipt of notice of enforcement action from DHCF pursua nt to this section, an HIE entity may request an administrative review of the action taken by DHCF in accordance with the procedures set forth in § 8713.

8711.8 DHCF shall publish and maintain guidance on nationally recognized standards for the secure access, use, and disclosure of health information on the DHCF website at www.dhcf.dc.gov.

8711.9 All other Medicaid requirements outlined in District laws and regulations, are applicable to HIE entities.

D.C. Mun. Regs. tit. 29, r. 29-8711

Final Rulemaking published at 65 DCR 8346 (7/19/2019)