Sunday, June 6, 2010

Proposed rules noticed in June 4 DCR

  • Proposed rules by Department of Health Care Finance (DHCF):   DHCF issued proposed rules in the June 4 DCR regarding health services for Medicaid recipients.   Proposed is a new DCMR section, “Medicaid Clinic Services and Reimbursement”; the guidelines in this section govern public and private non-hospital entities providing outpatient medical treatment to Medicaid beneficiaries.   Included in the proposed rules are the types of services and treatments to be provided along with the corresponding reimbursement methodologies.

    Further, to comply with federal law, DHCF is amending DC’s State Plan for Medical Assistance (State Plan) to reflect these changes.   According to the notice,

    The Council of the District of Columbia approved the resolution to request a State Plan Amendment (SPA) amending clinic services through Res. 16-478 on January 20, 2006.   The State Plan Amendment was approved by the U.S.   Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) on April 27, 2010 and became retroactively effective on October 1, 2009.

    Final action on the proposed rules will take place in not less than 30 days of publication.   The public is encouraged to submit written comments; see the rules for instructions.

  • Proposed rules by Department of Health Care Finance:   DHCF issued proposed rules establishing
    criteria for determining whether a service is medically necessary, a prerequisite for reimbursement by the Medicaid Program.   Federal law requires that State Plans for Medical Assistance (State Plans) assure that care and services covered under State Plans or early and periodic screening, diagnostic, and treatment services are medically necessary and provided in a manner consistent with the best interests of beneficiaries.   Federal law also requires State Plans to assure methods and procedures pertaining to utilization of and payment for care and services under the State Plan, as may be necessary to safeguard against unnecessary utilization of such care and services, and to assure that payments are consistent with efficiency, economy, and quality of care.

    The June 4 notice is the third to be published.   Numerous comments were submitted related to the initial notice published on August 29, 2008 (55 DCR 009330).   According to the notice they were taken into account for the second proposed rule publication on May 15, 2009 (56 DCR 003969).   The June 4 notice responds to comments made to the 2009 rule proposal.

    Final action on the proposed rules will take place in not less than 30 days of publication.   The public is encouraged to submit written comments; see the rules for instructions.

  • Proposed rules re: school-based health:   The Chancellor of the District of Columbia Public Schools issued proposed rules in the June 4 DCR

    to allow the Department of Health, the Department of Mental Health, and non-profit community-based health care providers to operate school health centers, to allow licensed providers in school-based health centers to dispense prescription and over-the-counter medications, and to clarify the role of school health centers in addressing the prevention of pregnancy and sexually-transmitted infections.   The existing section 2413 of Chapter 24 of Subtitle E of Title 5 will also be repealed as part of this rulemaking.

    These amendments were previously published as proposed rulemaking in the D.C. Register at 56 DCR 6702 on August 22, 2009.   DCPS considered all comments received, made changes to the proposed rulemaking, and is now republishing this proposed rulemaking for a second round of notice and comment.

    DCPS will submit these proposed rules to the Council of the District of Columbia for review and approval and become effective upon Council approval, or 45 days after submission, if the Council has not disapproved the proposed rulemaking, and publication of the final rules in the D.C. Register.

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