5001 PROVIDER QUALIFICATIONS

5001.1 A Provider receiving reimbursement for PCA services shall:

1. (a) Be a home care agency licensed pursuant to the requirements for home care agencies 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. (2005 Repl. & 2012 Supp.)), and implementing rules; and
2. (b) Be enrolled as a Medicare home health agency qualified to offer skilled services as set forth in Sections 1861(o) and 1891(e) of the Social Security Act and 42 CFR § 484.

5001.2 An applicant seeking reimbursement as a Provider under the Medicaid Program shall submit a Medicaid Provider Enrollment Application to the Department of Health Care Finance (DHCF), execute a Provider Agreement and be enrolled as such a Provider.

5001.3 Each Provider application shall contain, but not be limited to, the following:

- (a) Name, address, and business email of the applicant's organization and location of the applicant's place of business. An applicant shall submit a separate application for each place of business from which the applicant intends to offer District of Columbia Medicaid program services;

- (b) Answers sufficient to meet requirements as set forth in 42 C.F.R. § 455, subpart B: Disclosure of Information by Providers and Fiscal Agents;

- (c) Names, license numbers and National Provider Identifier (NPI) numbers of all individuals providing personal care services or nursing services from the National Plan and Provider Enumeration System (NPPES) as of the date of the application to become a District of Columbia Medicaid Provider;

- (d) The applicant's U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) Medicare Supplier Letter issued pursuant to 42 C.F.R. § 424.510 to evidence enrollment of the applicant in the Medicare program;

- (e) A copy or copies of all contracts held between the applicant and any staffing agency pertaining to the delivery of personal care services;

- (f) A copy or copies of license(s) held by the employees of any staffing

agency or agencies used by the Provider for the delivery of personal care services;

(g) The applicant’s NPI number as required by the Health Insurance Portability and Accountability Act of 1996 approved August 21, 1996 (Pub.L. No 104-191; 110 Stat. 1936);

(h) A copy of the applicant’s surety bond, pursuant to requirements set forth in § 5011 of this chapter; and

(i) A copy of a Certificate of Registration or Certificate of Authority, if required by District law or rules.

5001.4 A Provider shall submit a new Medicaid Provider Enrollment Application within thirty (30) days after any change in business ownership. Re-enrollment or continued enrollment in the Medicaid program after any change in business ownership shall be conditioned upon the Provider’s compliance with all applicable Federal and District requirements.

5001.5 A Provider shall submit a new Medicaid Provider Enrollment Application and successfully re-enroll in the D.C. Medicaid program at least every five (5) years from the date of execution of its most recent Provider Agreement.

5001.6 A Provider shall accept referrals from, and provide requested information to DHCF or its designated agent.

SOURCE: Final Rulemaking published at 50 DCR 3957 (May 23, 2003); as amended by Final Rulemaking published at 59 DCR 1760, 1762 (March 2, 2012); as amended by Final Rulemaking published at 60 DCR 15537 (November 8, 2013).