9715.1 DHCF may impose alternative sanctions against an ADHP when that provider fails to meet the programmatic requirements or any requirements set forth in this Chapter, but the violation does not place an ADHP participant's health or safety in immediate jeopardy.

9715.2 In lieu of terminating the Medicaid provider agreement, DHCF may impose one (1) or more alternative sanctions against ADHPs as set forth below:

1. (a) Denial of payments related to new admissions, as described in § 9716;
2. (b) Directed Plan of Correction (DPoC), as described in § 9717;
3. (c) Directed In-Service Training (DIST), as described in § 9718; or
4. (d) State Monitoring, as described in § 9719.

9715.3 DHCF shall make a determination to terminate a provider from the Medicaid program, or to impose an alternative sanction based on the following factors:

1. (a) Seriousness of the violation(s);
2. (b) Number and nature of the violation(s);
3. (c) Potential for immediate and serious threat(s) to ADHP participants;
4. (d) Potential for serious harm to ADHP participants;
5. (e) Any history of prior violation(s) and/or sanction(s);
6. (f) Mitigating circumstances; and
7. (g) Other relevant factors, including failing to achieve satisfactory scores during the annual Provider Readiness Review process.

9715.4 DHCF shall issue a written notice to each ADHP notifying the provider of the imposition of an alternative sanction. The written notice shall comply with the requirements outlined in Section 9714.

9715.5 All costs associated with the imposition of an alternative sanction against an ADHP pursuant to these rules shall be borne by the provider.

SOURCE: Final Rulemaking published at 63 DCR 1031 (January 29, 2016).