D.C. Mun. Regs. tit. 29, r. 29-4601

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

Rule 29-4601 - APPLICATION FOR CERTIFICATION

4601.1

An application to participate in the Medicaid/MCOTT Program shall be filed on forms provided by MAA.

4601.2

The MCOTT Application shall contain, but not be limited to, the following information:

(a) Name and address of the Provider organization and location of all of the Provider's places of business in the District or elsewhere in the United States;

(b) Names and addresses of the owners of the Provider organization;

(c) If the Provider organization is a corporation, the application shall include the names and addresses of all persons having a five percent (5%) or greater ownership interest and all officers and directors;

(d) The name of the physician who will be responsible for directing the services of the Provider's MCOTT Program; and

(e) The name of the Program Director.

D.C. Mun. Regs. tit. 29, r. 29-4601

Final Rulemaking published at 46 DCR 6122(July 23, 1999)