718.1 A participating DTP shall have an established fee schedule covering each of the services it provides for which a charge is made.

718.2 Medicaid shall not reimburse providers for services given without charge.

718.3 A participating DTP shall agree to accept as payment, in full, the amount determined by the Department of Human Services as the fee for the authorized services provided to Medicaid patients.

718.4 No additional charge shall be made to the Medicaid patient, any member of the family, or to any other source.

718.5 A participating DTP shall agree to bill any and all other known third party payors prior to billing Medicaid.

718.6 A participating DTP shall not file any false claims, statements, documents, or conceal any factual material. Violations of the provisions of this subsection may be prosecuted under applicable federal and District laws.

718.7 Reimbursement shall be at a negotiated rate and shall not exceed the maximum allowable per diem rate established by the D.C. OHFC for all programs.

718.8 [REPEALED]

AUTHORITY: The authority for § 718.8 is D.C. Code, 2001 Ed. § 1-307.02; Reorganization Plan No. 4 of 1996, 3 D.C. Code, 2001 Ed. at 413; and Mayor's Order 97-42 (February 18, 1997).

SOURCE: Final Rulemaking published at 31 DCR 326 (January 27, 1984); as amended by final rulemaking published at 50 DCR 6702 (August 15, 2003); as amended by final rulemaking published at 55 DCR 8521 (August 8, 2008).