9406.1 Pursuant to 42 CFR § 455.450, the following provider types shall be assigned to the “high” risk category:

1. (a) Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers;
2. (b) DMEPOS providers of medical alert devices and services;
3. (c) Home health agencies; and
4. (d) Other providers who have been elevated to the “high” risk category in accordance with § 9403.4.

9406.2 Screening for providers designated as “high” risk shall include the following:

1. (a) Verification that the provider meets requirements set forth in the D.C. Health Occupations Revision Act of 1985, as amended, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq.) and implementing rules, as well as all other applicable federal and District laws and regulations, including, where appropriate, the requirements of 42 CFR § 441.301(c);
2. (b) Verification of appropriate licensure, including licensure in states other than the District, in accordance with 42 CFR § 455.412;
3. (c) On-site visits conducted in accordance with 42 CFR § 455.432;
4. (d) Criminal background checks, pursuant to 42 CFR § 455.434;
5. (e) Submission of fingerprints, pursuant to 42 CFR § 455.434, for all providers or individuals who maintain a five percent (5%) or greater direct or indirect ownership interest in the provider; and
6. (f) Both pre- and post-enrollment Federal database checks to ensure the provider meets and continues to meet the enrollment criteria corresponding to its provider type, in accordance with 42 CFR § 455.436.

SOURCE: Final Rulemaking published at 60 DCR 10041 (July 12, 2013); as amended by Final Rulemaking published at 68 DCR 4255 (April 23, 2021).