9409.1 In accordance with 42 CFR § 455.432, DHCF shall conduct unannounced, pre-enrollment and post-enrollment site visits of providers who are designated as “moderate” risk or “high” risk. Site visits shall be used to verify the following:

(a) The accuracy of the information submitted to DHCF;

(b) The operational status of the provider’s business; and

(c) The provider’s compliance with all applicable federal and District laws.

9409.2 For in-District providers, DHCF may conduct the required site visits or may, at DHCF’s discretion, rely on the results of a site visit conducted by another District government agency.

9409.3 For out-of-District provider, DHCF may rely upon the results of a site visit conducted by either the appropriate government agency of the state in which the provider is located or the Medicare program.

9409.4 In circumstances where all other options have been exhausted, DHCF reserves the right to satisfy the site visit requirement through a telephonic survey.

9409.5 DHCF reserves the right to conduct unannounced site visits of any provider at any point during the screening process and/or period of District Medicaid enrollment.

9409.6 Providers are required to permit on-site inspections conducted by the U.S. Department of Health and Human Services, including CMS, the Department of Health (DOH), DHCF, or any designee selected by any of the aforementioned.

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