Chapter 12D. Stevie Sellow's Quality Improvement Fund; ICF-IDD [ICF-IID] Assessment.
§ 47–1270. Definitions.
For the purposes of this chapter, the term:
(1) “Administrative costs” means the costs of DHCF to administer, manage, and monitor the Intermediate Care Facility for People with Intellectual Disabilities reimbursement program and the Stevie Sellow's quality improvement funding support, including personnel costs.
(1A) "DD waiver provider" means an entity that provides residential, in-home, day, or support services, including employment and community development services under the District's Medicaid Home and Community-Based Services Waiver for Persons with Intellectual and Developmental Disabilities program as authorized by section 1915(c) of the Social Security Act, approved August 13, 1981 (95 Stat. 809; 42 U.S.C. § 1396n(c)).
(1B) “DHCF” means the Department of Health Care Finance.
(1C) “Fund” means the Stevie Sellow's Quality Improvement Fund established by this chapter.
(2) “Gross revenue” means the sum of revenue for provisions of services to consumers with developmental disabilities. For purposes of this chapter, gross revenues does not include charitable contributions or interest income.
(2A) “ICF/IID” means Intermediate Care Facility for People with Intellectual Disabilities.
(3) “Intermediate care facility for persons with intellectual or developmental disabilities” and “ICF-IDD” have the same meaning as under 42 U.S.C. 1396d(d), but do not include a facility operated by the federal government.
(4) “Medicaid” means the medical assistance programs authorized by title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), and by [§ 1-307.02], and administered by DHCF.
(5) “Quality of care improvements” means improving the quality of care for consumers with developmental disabilities by efforts to reduce turnover and increase the qualifications of the employees, excluding managers, administrators, and contract employees, such as an increase in salaries or benefits, or an increase in training and educational opportunities.
(5A) “Rebasing year” means the third year after the effective date of the State Plan Amendment governing the reimbursement of ICF/IID and every subsequent third year.
(6) “Resident” means a person receiving services in an ICF-IDD.
(7) “Reimbursement methodology” means the prospective Medicaid payment rate system for intermediate care facilities for persons with intellectual disabilities.
§ 47–1271. [Stevie Sellow's] Quality Improvement Fund.
(a) There is established a fund designated as the Stevie Sellow's Quality Improvement Fund (“Fund”), which shall be separate from the General Fund of the District of Columbia and shall be used for the purposes set forth in subsection (b) of this section. All assessments collected under this chapter, any and all interest earned on those assessments, and any and all interest and penalties collected under § 47-1274, shall be deposited into the Fund, and shall not revert to the General Fund of the District of Columbia at the end of any fiscal year or at any other time, but shall be continually available for the uses and purposes set forth in subsection (b) of this section, subject to authorization by Congress.
(b) The Fund shall be used to:
(1) Fund quality of care improvements for those facilities that meet the requirements of the District’s State Plan for Medical Assistance and the accompanying rules governing the reimbursement of ICF/IID; provided, that if the quality-of-care improvement is for an increase in salaries, the total payment amount, on average, for qualifying direct support professionals should be up to the greater of 117.6% of the District minimum wage pursuant to § 32-1003 or 117.6% of the District living wage pursuant to subchapter X-A of Chapter 2 of Title 2.
(2) Cover administrative costs of the DHCF in administering the ICF/IID reimbursement program and the Stevie Sellow's quality improvement funding support, which costs shall not be more than 10% of the Fund’s total revenues; and
(3) Cover administrative costs of DHCF in auditing the ICF/IID in a rebasing year or as necessary to ensure the integrity of the ICF/IID reimbursement methodology, which costs shall not be more than 15% of the Fund’s total revenues.
(c) Notwithstanding subsection (b) of this section, of the revenues deposited in the Fund in fiscal year 2011, at least $1 million shall be used to support quality of care improvements for those facilities that meet the requirements of § 47-1272, and up to $3.7 million may be used to support Medicaid services in the District of Columbia, including reimbursements for ICF/IIDs for the services that they provide.
(c-1) Notwithstanding subsection (b) of this section, revenues deposited in the Fund beginning in Fiscal Year 2022 may be used to support quality of care improvements for DD waiver providers.
(d) The Mayor shall submit to the Council, as a part of the annual budget, a requested appropriation for expenditures from the Fund for a fiscal year.
(e) The Mayor shall audit all income and expenses of the Fund annually and provide the annual report to the Council.
§ 47–1272. Qualified Facility; eligibility; inspection by the [DCHF]; fund recovery; adverse action prohibition.
(a) To be eligible to receive payments from the Fund for a fiscal year, an ICF-IDD [ICF-IID] or DD waiver provider shall submit the following to the DHCF by June 30 of the prior fiscal year:
(1) Proof of a legally binding written commitment to fund quality of care improvements as defined in § 47-1270;
(2) Proof of an enforcement mechanism of the written commitment to fund quality of care improvements, such as arbitration, that is:
(A) Expeditious;
(B) Uses a neutral decision maker;
(C) Economical for the employees; and
(D) Available to the employees or their representatives; and
(3) Proof that the facility has provided written notice of the terms of the commitment and the availability of the enforcement mechanism to the relevant employees or their recognized representatives.
(b) The DHCF shall terminate the quality improvement funding for a facility if it finds the binding written commitment has expired and does not otherwise remain enforceable.
(c) The DHCF may inspect relevant payroll and personnel records of facilities receiving funds pursuant to this section to ensure that the quality of care improvements provided for in this section have been implemented.
(d) In addition to the remedies provided in § 47-1274, the DHCF may retroactively recover funds provided to a facility for quality of care improvements incurred after expiration of the commitment or if a facility has failed to maintain the commitment.
(e) Enforcement or attempted enforcement of the written commitment pursuant to § 47-1272 shall not constitute a basis for adverse action by a facility against an employee.
(f) Documents submitted by the ICF-IDD [ICF-IID] or DD waiver provider to show its compliance with § 47-1272 shall be available for public review.
§ 47–1273. Assessments on ICF/IID.
(a) Except as provided in § 47-1278(d), each ICF/IID in the District of Columbia shall pay an assessment of 6.0% of the gross revenues per annum.
(b) Each ICF/IID shall pay the assessment required by subsection (a) of this section in quarterly installments.
(c) The Mayor shall provide notice of the amount of the assessment for the quarter to each ICF/IID no later than 30 days after the end of each quarter.
(d) The assessment required by subsection (a) of this section shall be determined by the Medicaid claims information from the DHCF Medicaid Management Information System.
(e) If the total amount of the assessments to be collected for a fiscal year is inadequate to cover disbursements required under § 47-1271(b), the Mayor may raise the assessment to the maximum allowed under federal law.
§ 47–1274. Interest and penalties.
(a)(1) If an ICF-IDD [ICF-IID] fails to pay the full amount of an assessment by the date required by this chapter, or by rules issued pursuant to § 47-1277, the unpaid balance shall accrue interest at the rate of 1.5% per month or any fraction thereof which shall be added to the unpaid balance.
(2) The Chief Financial Officer of the District of Columbia may arrange a payment plan for the amount of the assessment and interest in arrears.
(b) [Repealed].
(c)(1) If an ICF-IDD [ICF-IID] that knowingly provides false information in a report required by this chapter, or by rules issued pursuant to § 47-1277, it shall be subject to a penalty of up to $10,000.
(2) Any action brought to enforce this subsection shall be brought in the Superior Court of the District of Columbia by the Attorney General for the District of Columbia in the name of the District of Columbia.
(d) The District of Columbia shall have:
(1) A lien upon the real and personal property located in the District of Columbia of the ICF-IDD [ICF-IID] for any assessments, interest, or administrative penalties that are due under this chapter, or rules issued pursuant to § 47-1277; and
(2) The priority of a secured creditor.
§ 47–1275. Confidentiality; audit; determination of assessment.
(a) Unless otherwise provided by law or necessary to carry out the provisions of this chapter, proprietary information submitted by an ICF-IDD [ICF-IID] or DD waiver provider under this chapter is confidential and shall not be disclosed.
(b) The Mayor may audit the information required to be reported by an ICF-IDD [ICF-IID] or DD waiver provider under this chapter, or any rules issued pursuant to § 47-1277, and may use the audited information to determine, or redetermine, the amount of an assessment due under this chapter.
(c)(1) The Mayor may summon any person to appear to give testimony or answer interrogatories, or to produce books, records, or other information relating to matters subject to an audit.
(2) The summons shall be served by a member of the Metropolitan Police Department or by registered mail or certified mail addressed to the person at the last known dwelling place or principal place of business.
(3) A verified return by the person serving the summons, or, in the case of service by registered or certified mail, the return post office receipt signed by the person served shall be proof of service.
(d) The Mayor may report a person who, having been served pursuant to subsection (c) of this section, neglects or refuses to obey the summons, to the Superior Court of the District of Columbia. The Superior Court may compel obedience to the summons to the same extent as witnesses may be compelled to obey subpoenas of the Superior Court.
§ 47–1276. Appeals.
(a) An ICF-IDD may contest the amount of an assessment, including any interest or administrative penalties, imposed under this chapter, or by rules issued pursuant to § 47-1277, by filing a notice of appeal with the Office of Administrative Hearings within 60 days after the date of the notice of:
(1) An annual assessment under § 47-1273;
(2) A determination or redetermination of an assessment based on an audit of information under § 47-1275; or
(3) An imposition of interest or administrative penalties under § 47-1274.
(b) The Office of Administrative Hearings shall conduct a hearing on the appeal filed under subsection (a) of this section subject to the District of Columbia Administrative Procedure Act, approved October 21, 1968 (82 Stat. 1204; § 2-501 et seq.), and pursuant to the rules of the Office of Administrative Hearings.
(c) Before filing an appeal pursuant to subsection (a) of this section, the ICF-IDD shall pay the assessment, together with any administrative penalties and interest due on the assessment. In no case shall the filing of a notice of appeal act as a stay on the payment of the assessment, interest, or administrative penalties.
§ 47–1277. Rules.
The Mayor, in consultation with the Department of Health and ICF-IDD and employee representatives, shall issue rules to implement the provisions of this chapter.
§ 47–1278. Federal determinations; suspension and termination of assessment.
(a) If the federal government determines that an assessment imposed on an ICF-IDD pursuant to this chapter does not satisfy the requirements for federal financial participation set forth in section 1903(w) of the Social Security Act, approved July 30, 1965 (70 Stat. 349; 42 U.S.C. § 1396b(w)), monies collected pursuant to the assessment shall be refunded and the assessment shall be null and void.
(b)(1) An [sic] determination adverse to the District under subsection (a) of this section with respect to an assessment imposed on one or more, but not all ICF-IDDs pursuant to this chapter shall not affect the validity, amount, applicable rate, or any other terms of an assessment on other facilities imposed by this chapter.
(2) An adverse determination with respect to all assessments imposed by this chapter shall be governed by subsection (a) of this section.
(c) Notwithstanding any other provision of this chapter, if the federal government determines that any exclusions from ICF-IDDs specified under this chapter would prevent an assessment imposed by this chapter from qualifying as a broad-based health care related tax, as that term is defined in section 1903(w)(3)(B) of the Social Security Act, approved July 30, 1965 (79 Stat. 349; 42 U.S.C. § 1396b(w)(3)(B)), the exclusions shall not be made.
(d) The assessment imposed under § 47-1273 shall not be due at the time required by this chapter, or by rules issued pursuant to § 47-1277, if the Department of Health suspends or postpones regular Medicaid payment to ICF-IDDs beyond the regular monthly payment cycle, but shall be due when the regular monthly payment cycle resumes.
(e) The assessment imposed under § 47-1273 shall be null and void if either of the following occurs:
(1) The rate methodology for ICF-IDDs is altered or amended such that the overall average Medicaid per diem rate for ICF-IDDs is decreased or on, an overall average per diem basis, the altered or amended rates are less than they would have been if the reimbursement methodology had not been changed; or
(2) Following fiscal year 2006, general funding levels for Medicaid rates for ICF-IDDs fall below the fiscal year 2006 level of funding, on a per-Medicaid-resident, per-day basis.
