10204.1 The following types of organizations may become My Health GPS entities:

1. (a) Primary care clinical individual practices;
2. (b) Primary care clinical group practices; and
3. (c) Federally Qualified Health Centers.

10204.2 In order to be eligible to become a My Health GPS entity, organizations described in § 10204.1 shall:

1. (a) Be enrolled as a D.C. Medicaid provider in accordance with the requirements set forth in Chapter 94 of Title 29 DCMR;
2. (b) Have no current or pending investigations, exclusions, suspensions or debarment from any federal, State or District healthcare program; and
3. (c) Have no outstanding overpayment from DHCF.

10204.3 In addition to the minimum requirements set forth in §§ 10204.1 and 10204.2, each applicant shall be required to:

1. (a) Provide proof of National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) Level Two recognition (or successor version of equivalent recognition) or proof that the organization has initiated the NCQA PCMH application process for the prospective My Health GPS entity and that the recognition has been achieved within twelve (12) months of the date of submission of the My Health GPS application;
2. (b) Demonstrate use of certified electronic health record (EHR) technology to support the creation and execution of a person-centered plan of care for each beneficiary;
3. (c) Provide twenty-four (24) hour, seven (7) days per week access to clinical advice, including culturally appropriate translation and interpretation services for beneficiaries with limited English proficiency;
4. (d) Demonstrate the availability of an interdisciplinary team with sufficient capacity to serve eligible beneficiaries including, at a minimum, qualified practitioners to fill each of the roles described in §§ 10205.3 and 10205.4;

(e) Demonstrate the ability to deliver all My Health GPS services in accordance with the requirements described in § 10206, either directly through the organization or through a subcontractor;

(f) Establish and maintain data sharing agreements with other healthcare providers as necessary in order to comply with all applicable requirements of the Health Insurance Portability and Accountability Act of 1996, effective August 21, 1996 (Pub. L. 104-191, 110 Stat. 1936); and

(g) Provide proof of enrollment in the Chesapeake Regional Information System for Patients (CRISP) or comparable system, to receive hospital and emergency department alerts for enrolled beneficiaries.

10204.4 DHCF shall review applications from organizations described in § 10204.1 to become My Health GPS entities at the following times:

(a) Applications shall initially be accepted for a thirty (30) day period which occurs prior to the program implementation date and which shall be communicated to all prospective My Health GPS entities on the DHCF website at: http://dhcf.dc.gov; and

(b) Following the initial thirty (30) day application period, applications shall be reviewed on an ongoing basis.

10204.5 A prospective My Health GPS entity shall not be eligible for the initial assignment of eligible beneficiaries as described in § 10202.3, if the application is not received within the thirty (30) day period described in § 10204.4(a) and approved by DHCF.

10204.6 Approval of a prospective My Health GPS entity's application shall be contingent upon the entity's successful completion of a readiness review.

10204.7 DHCF shall return each application that is incomplete and afford the applicant two (2) opportunities to re-submit the application.

10204.8 If the applicant does not meet all of the requirements set forth in this chapter, DHCF shall deny enrollment in the My Health GPS program and issue a notice consistent with the requirements set forth in Chapter 94 of Title 29 DCMR.

SOURCE: Final Rulemaking published at 65 DCR 0636 (January 26, 2018).