D.C. Mun. Regs. tit. 29, r. 29-9411

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

Rule 29-9411 - NOTICE AND APPEALS

9411.1

If under this chapter the Director proposes to terminate the provider agreement or deny enrollment to an applicant or reenrolling provider or supplier, then the Director shall send written notice to the provider or Applicant. The notice shall include the following:

(a) The basis and reasons for the proposed termination of the provider agreement or denial of enrollment;

(b) The provider's or applicant's right to dispute the allegations and to submit evidence to support his or her position; and

(c) Specific reference to the particular sections of relevant statutes, rules, provider agreement and/or provider manuals.

9411.2

Within thirty (30) days of the date on the notice, the provider, applicant or reenrolling provider or supplier may submit documentary evidence and accompanying written argument against the proposed termination or denial of enrollment.

9411.3

If the Director decides to terminate the provider agreement or deny enrollment after the provider, applicant or reenrolling provider or supplier files a response, then the Director shall send written notice of the termination or denial of enrollment to the provider, applicant or reenrolling provider or supplier. The notice shall be sent at least fifteen (15) days before the decision becomes effective, and shall include the following:

(a) The reason for decision;

(b) The effective date of the decision;

(c) The earliest date on which the Director shall accept an application for enrollment or a request for reinstatement;

(d) The requirements and procedures for enrollment in the District's Medicaid Program; and

(e) The provider, applicant or reenrolling provider or supplier's right to request a hearing by filing a notice of appeal with the Office of Administrative Hearings.

9411.4

If the provider, applicant or reenrolling provider or supplier files a notice of appeal within fifteen (15) days of the date of the notice of termination or denial of enrollment, then the effective date of the proposed action shall be stayed pending a decision following final action by the Office of Administrative Hearings.

D.C. Mun. Regs. tit. 29, r. 29-9411

Final Rulemaking published at 60 DCR 10041 (July 12, 2013)

Authority: An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2006 Repl. & 2012 Supp.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2008 Repl.)).