1300.1 This chapter governs the administrative actions the Department may take with respect to providers who participate in the District of Columbia Medicaid Program. The administrative actions are as follows:

1. (a) Exclusion, termination and/or suspension of a provider from the program;
2. (b) Suspension of payments, in whole or in part, to recover or aid in the recovery of overpayments to a provider;
3. (c) Suspension of payments, in whole or in part, to aid in determining if overpayments have been made to a provider or if a program payment is correct;
4. (d) Determination by the Department of Human Services (DHS) of program reimbursement on the basis of cost reports filed by a provider;
5. (e) Requests for reinstatement by a provider in the program; and
6. (f) Procedures to appeal actions taken under this subsection.

1300.2 This chapter shall be construed in conjunction with Title XIX of the Social Security Act, applicable federal regulations, pertinent District laws, regulations governing the District's Medicaid program pursuant to §1-359, D.C. Code, 1981 ed., and the District of Columbia Office of Health Care Financing Provider Manual.

1300.3 This chapter shall not apply if the Department of Human Services does not reimburse a facility due to lack of certification.

AUTHORITY: Unless otherwise noted, the authority for this chapter is D.C. Code, 2001 Ed. §1-307.02; Reorganization Plan No. 2 of 1979, 3 D.C. Code, 2001 Ed. at 338; 42 C.F.R. §§431.54(f),

447.45, and 455.200 et seq.; and 42 U.S.C. §1396.

SOURCE: Final Rulemaking published at 31 DCR 3870 (August 3, 1984).