9412.1 DHCF may terminate enrollment of a provider due to inactivity if:

1. (a) A provider fails to submit the first claim under the provider number initially issued to the provider within a period of twelve (12) months from the date the provider number was issued by DHCF or its designee; or
2. (b) A provider number that has had at least one (1) Medicaid claim submitted for payment has no claim submitted under that provider number for twelve (12) consecutive months.

9412.2 At the conclusion of a period of twelve (12) consecutive months, during which there were no Medicaid claims submitted for payment under a particular provider number, DHCF shall issue a notice advising the provider of the pending termination of enrollment due to inactivity.

9412.3 A notice of termination due to provider inactivity shall:

1. (a) Be issued to the provider thirty (30) calendar days prior to action by DHCF;
2. (b) Be in writing;
3. (c) Be mailed to a provider's last known mailing address;
4. (d) State the reason for the termination due to inactivity;
5. (e) State the effective date of the termination due to inactivity; and
6. (f) Information regarding the provider's right to request a hearing by filing a notice of appeal with the Office of Administrative Hearings.

9412.4 A provider who seeks to remain in active status shall notify DHCF orally or in writing within thirty (30) calendar days of the date of the notice described at §§ 9412.2 and 9412.3.

9412.5 A provider who fails to notify DHCF pursuant to § 9412.4 shall be terminated upon the effective date stated in the notice described at §§ 9412.2 and 9412.3.

9412.6 DHCF shall not make payments for claims, submitted by any provider whose enrollment in has been terminated due to inactivity, for services rendered on or after the date of termination.

9412.7 All terminations initiated by the Director shall be in accordance with the District

Medicaid Program Administrative Procedures set forth in Chapter 13 of Title 29 DCMR.

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