1903 PROVIDER QUALIFICATIONS

1903.1 Social Service Agency or Sole Proprietor Agency applicants shall complete an application to participate in the Medicaid Waiver program and shall submit to DDS both the application and following organizational information:

1. (a) A description of ownership and a list of major owners or stockholders owning or controlling five (5) percent or more outstanding shares;
2. (b) A list of Board members and their affiliations;
3. (c) A roster of key personnel, with qualifications, resumes, and a copy of their position descriptions;
4. (d) A copy of the most recent audited financial statement of the organization;
5. (e) A completed copy of the waiver provider application;
6. (f) A copy of the basic organizational documents of the provider, including an organizational chart, and current Articles of Incorporation or partnership agreement, if applicable;
7. (g) A copy of the Bylaws or similar documents regarding conduct of the provider's internal affairs;
8. (h) A copy of the business license and or certificate of good standing;
9. (i) A copy of professional/business liability insurance of at least one (1) million dollars;
10. (j) Organizational policies and procedures, such as personnel policies and procedures, human rights, incident reporting, behavioral support policies, staff training, protection of consumer funds, and others as required by DDS;
11. (k) A continuous quality improvement plan; and
12. (l) Any other documentation deemed necessary to support the approval as a provider.

1903.2 Professional service provider applicants who are in private practice as an independent practitioner shall complete an application to participate in the Medicaid Waiver program and shall agree to:

1. (a) Maintain a private office, even if services are always furnished in the home of the person receiving services;
2. (b) Meet all state and local licensure laws and rules;
3. (c) Maintain at least one (1) million dollars in liability insurance;
4. (d) Ensure that services provided are consistent with the individual habilitation plan (IHP) or individual service plan (ISP) and Plan of Care;
5. (e) Ensure that, if services are furnished in a private practice office space, that space shall be owned, leased, or rented by the private practice and shall be used for the exclusive purpose of operating the private practice; and
6. (f) Personally supervise assistants and aides employed directly by the independent

practitioner, by the partnership group to which the independent practitioner belongs, or by the same private practice that employs the independent practitioner. Personal supervision requires the independent practitioner to be in the room during the performance of the service.

1903.3 Home Health Agency or Skilled Nursing Service provider applicants shall complete an application to participate in the Medicaid Waiver program and shall meet the definitions and licensure requirements to participate as a Home Health Agency or Skilled Nursing Service as follows:

(a) Home Health Agency - Shall have the same meaning as "home care agency" and shall meet the definitions and licensure requirements as set forth in the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code § 44-501 et seq.), and implementing rules; and

(b) Skilled Nursing Service - Health care services that are delivered by a registered or practical nurse acting within the scope of their practice and shall meet the definitions and licensure requirements as set forth in the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1201 et seq.), and implementing rules.

1903.4 Each service provider under the Waiver for which transportation is included in the Waiver service shall:

(a) Ensure that each vehicle used to transport an individual has valid license plates;

(b) Ensure that each vehicle used to transport an individual has at least the minimum level of motor vehicle insurance required by law;

(c) Present each vehicle used to transport an individual for inspection by a certified inspection station every six months (or as required in the jurisdiction where the vehicle is registered) and provide proof that the vehicle has passed the inspection by submitting a copy of the Certificate of Inspections to DDS upon request;

(d) Ensure that each vehicle used to transport an individual is maintained in safe, working order,

(e) Ensure that each vehicle used to transport an individual meets the needs of the individual;

(f) Ensure that each vehicle used to transport an individual has seats fastened to the body of the vehicle;

(g) Ensure that each vehicle used to transport an individual has operational seat belts;

(h) Ensure that each vehicle used to transport an individual has temperature conducive to comfort;

(i) Ensure that each vehicle used to transport an individual is certified by the Washington Metropolitan Area Transit Commission;

(j) Ensure that each individual is properly seated when the vehicle is in operation;

(k) Ensure that each individual is transported to and from each appointment in a timely manner;

(l) Ensure that each individual is provided with an escort on the vehicle, when needed;

(m) Ensure that each vehicle used to transport a person with mobility needs is adapted to provide safe access and use;

(n) Ensure that each person providing services meet the requirements set forth in section 1911 of these rules; and

(o) Ensure that each person providing services be certified in cardiopulmonary resuscitation and First Aid.

1903.5 MAA shall notify each prospective provider, in writing, of the approval or disapproval to become a provider of Waiver services, no later than fifteen (15) days of receipt of all required documentation. If additional information is requested by MAA, the provider shall have thirty (30) days from the date of the request to submit the additional information. If an application is disapproved, the notice shall set forth the reason for disapproval. Failure to submit all required documentation may result in disapproval.

1903.6 Each provider shall enter into a provider agreement with MAA for the provision of Waiver services.

1903.7 The provider agreement shall specify the services to be provided, methods of operation, financial and legal requirements, and identification of the population to be served.

1903.8 Each provider shall be subject to the administrative procedures set forth in Chapter 13 of Title 29 DCMR, to the provider certification standards established by DDS (currently known as the Basic Assurance Standards Authorization process), and to all policies and procedures promulgated by DDS that are applicable to providers during the provider's participation in the Waiver program.

1903.9 Each provider shall comply with all applicable provisions of District and federal law and rules applicable to the Title XIX of the Social Security Act, and all District and federal law and rules applicable to the service or activity provided pursuant to these rules.

SOURCE: Final Rulemaking published at 51 DCR 10207 (November 5, 2004); as amended by Final Rulemaking published at 55 DCR 2882 (March 21, 2008).