D.C. Mun. Regs. tit. 29, r. 29-4107

Current through Register 71, No. 45, November 7, 2024

Rule 29-4107 - FISCAL ACCOUNTABILITY

4107.1

Effective October 1, 2013 through September 30, 2017, except for the Administration, Capital, and Active Treatment cost centers, each facility shall spend at least ninety-five percent (95%) of the rate under each cost center on service delivery to Medicaid individuals. Facilities expending less than ninety-five percent (95%) of each cost center shall be subject to repayment requirements set forth in Subsection 4107.6.

4107.2

Effective October 1, 2013 through September 30, 2017, each ICF/IID shall spend one hundred percent (100%) of the rate for Active Treatment on service delivery to Medicaid individuals. Facilities expending less than one hundred percent (100%) of the rate for Active Treatment shall be subject to repayment requirements set forth in Subsection 4107.6.

4107.3

Effective January 1, 2014 through September 30, 2017, each ICF/IID shall spend one hundred percent (100%) of the rate associated with the Capital cost center. A facility that fails to expend one hundred percent (100%) on capital shall be subject to repayment requirements set forth in Subsection 4107.6.

4107.4

Effective November 1, 2017, each ICF/IID shall spend at least ninety-five percent (95%) of the rate for Direct Service and one-hundred percent (100%) of the rate for Active Treatment on service delivery to Medicaid beneficiaries. Facilities expending less than ninety-five percent (95%) of the rate for Direct Service or one-hundred percent (100%) of the rate for Active Treatment shall be subject to repayment requirements set forth in Subsection 4107.6.

4107.5

Effective November 1, 2017, each ICF/IID shall spend at least ninety-five percent (95%) of the aggregate rate for the All Other Health Care and Program Related, Non Personnel Operations, Non-Emergency Transportation, and Capital cost centers. Facilities expending less than ninety-five percent (95%) of the aggregate rate for these four (4) cost centers shall be subject to repayment requirements set forth in Subsection 4107.6.

4107.6

Repayment amounts shall be as follows:

(a) The repayment amount described in § 4107.1 shall be the difference between ninety-five percent (95%) of the rate for the applicable cost center(s) and the facility's reported expenses for the applicable cost center(s);

(b) The repayment amount for Active Treatment described in § 4107.2 shall be the difference between one hundred percent (100%) of the payments made for Active Treatment and the facility's reported expenses for Active Treatment;

(c) The repayment amount for Capital described in § 4107.3 shall be the difference between one hundred percent (100%) of the payments made for Capital and the facility's reported Capital expenses;

(d) The repayment amounts described in § 4107.4 shall be as follows:

(1) The difference between ninety-five percent (95%) of the Direct Service rate and the facility's reported Direct Service expenses; and

(2) The difference between one-hundred percent (100%) of the Active Treatment rate and the facility's reported Active Treatment expenses; and

(e) The repayment amount described in § 4107.5 shall be the difference between ninety-five percent (95%) of the aggregate rate for the All Other Health Care and Program Related, Non Personnel Operations, Non-Emergency Transportation, and Capital cost centers and the facility's reported aggregate expenses for these four (4) cost centers.

4107.7

In accordance with D.C. Official Code § 47-1272(c), DHCF, or its designee, has the right to inspect payroll and personnel records to support the Department's obligations pursuant to the Living Wage Act of 2006, effective March 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 47-1270et seq.), and implementing regulations.

4107.8

DHCF shall evaluate expenditures subject to the requirements in this section through annual review of cost reports. DHCF, or its designee, shall review each cost report for completeness, accuracy, compliance, and reasonableness through a desk audit.

4107.9

On-site audits shall be conducted not less than once every three (3) years. Each ICF/IID shall allow access, during on-site audits or review by DHCF or U.S. Department of Health and Human Services auditors, to relevant financial records and statistical data to verify costs previously reported to DHCF.

4107.10

DHCF shall issue a notice to each ICF/IID that is required to repay as set forth in this section. The notice shall set forth the repayment amount and include language describing the procedure and timeframes for requesting an appeal before OAH. Filing an appeal with OAH shall not stay any action to recover the amounts prescribed in this section.

D.C. Mun. Regs. tit. 29, r. 29-4107

Final Rulemaking published at 60 DCR 11590 (August 9, 2013); as Amended by Final Rulemaking published at 61 DCR 12231 (November 28, 2014); amended by Final Rulemaking published at 63 DCR 297 (1/8/2016); amended by Final Rulemaking published at 65 DCR 2435 (3/9/2018)

Authority: An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2006 Repl. & 2012 Supp.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6)) (2008 Repl.).