District of Columbia Administrative Code

1000 GENERAL PUBLIC ASSISTANCE ELIGIBILITY 1000.1 With respect to the General Public Assistance Program, alcohol and drug abuse, in and of themselves shall not be the factors used to determine the unemployability of the user. 1000.2 Only physical or mental ailments as described b…

1001 ALCOHOLIC TREATMENT REIMBURSEMENTS 1001.1 The provisions of this section shall govern the reimbursement for treatment services provided to alcoholic patients by the District government in accordance with the provisions of §14 of Public Law 90-452, the District Alcoholic Reha…

10000 GENERAL PROVISIONS 10000.1 These rules establish the standards and conditions of reimbursement of lactation services under the District of Columbia Medicaid Program. 10000.2 The provisions of this chapter governing conditions of participation for providers of lactation serv…

10001 LACTATION CONSULTATION, EDUCATION, AND SUPPORT 10001.1 Lactation consultation, education, and support shall mean evaluation of the mother and infant’s overall breastfeeding readiness, education on proper breastfeeding techniques, education on the proper use of a breast pump…

10002 BREAST PUMPS AND LACTATION SUPPLIES 10002.1 Breast pumps described under Subsection 10002.3 and lactation supplies described under Subsection 10002.4 are reimbursable for mothers with infants under “durable medical equipment,” subject to any requirements set forth in the Di…

10003 BANKED DONOR MILK 10003.1 Medicaid-reimbursable banked donor milk shall be provided on an outpatient basis for Medicaid-eligible mothers with infants, and shall be provided in accordance with the following requirements: The infant is between the age of zero (0) and twelve (…

10004 RECORDS 10004.1 Each provider shall maintain complete and accurate records reflecting the specific lactation services ordered and provided to each beneficiary. Additionally, the ordering physician of donated human milk and the donated human milk bank shall each maintain cop…

10005 REIMBURSEMENT 10005.1 Each provider shall comply with the requirements set forth in Chapter 14 (Health-Care Assistance Reimbursement) of Title 29 DCMR. 10005.2 DHCF shall establish fees and reimbursement for only those services outlined in Subsections 10001 through 10003. R…

10006 AUDITS AND REVIEWS 10006.1 DHCF shall perform audits to ensure that Medicaid payments are consistent with efficiency, economy, and quality of care and made in accordance with federal and District rules governing Medicaid. 10006.2 Each Provider shall allow access to relevant…

HYPERLINK "http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=DC-MR&DocName=LK%2829DCADCS899%29&FindType=l" 10099 DEFINITIONS 10099.1 When used in this chapter, the following terms and phrases shall have the meanings ascribed: Breast pump - A device used to extract breast…

10100 GENERAL PROVISIONS 10100.1 The Services My Way program shall be established as the Medicaid participant-directed services (PDS) program in the District of Columbia to afford persons enrolled in the Home and Community-Based Services Waiver for the Elderly and Persons with Ph…

10101 OUTREACH AND ENROLLMENT 10101.1 Both current EPD Waiver beneficiaries and new EPD Waiver enrollees who meet the requirements of § 10100.2 may elect to enroll in the Services My Way program. 10101.2 DHCF or its agent shall provide information regarding self-direction and the…

10102 PARTICIPANT-DIRECTED COMMUNITY SUPPORT SERVICES: SERVICE DESCRIPTION 10102.1 PDCS services shall be available only to EPD Waiver beneficiaries enrolled as participants in the Services My Way program. 10102.2 PDCS services shall be detailed in the participant’s PCP and PDS b…

10103 PARTICIPANT-DIRECTED COMMUNITY SUPPORT SERVICES: PROVIDER REQUIREMENTS 10103.1 PDCS services shall be provided only to EPD Waiver beneficiaries enrolled as participants in the Services My Way program. 10103.2 Qualified PDWs shall provide PDCS services as employees of Servic…

10104 INDIVIDUAL-DIRECTED GOODS AND SERVICES: SERVICE DESCRIPTION 10104.1 Individual-directed goods and services are only available to EPD Waiver beneficiaries who are enrolled as participants in the Services My Way program, and if they are purchased from the participant’s PDS bu…

10105 INDIVIDUAL-DIRECTED GOODS AND SERVICES: PROVIDER REQUIREMENTS 10105.1 Individual-directed goods and services shall be provided only to EPD Waiver beneficiaries enrolled as participants in the Services My Way program. 10105.2 All individuals and vendors providing individual-…

10106 VENDOR FISCAL/EMPLOYER AGENT FINANCIAL MANAGEMENT SERVICES-SUPPORT BROKER ENTITY FUNCTIONS 10106.1 Services My Way participants shall receive financial management services and information and assistance services through the VF/EA FMS-Support Broker entity selected by DHCF t…

10107 PARTICIPANT-DIRECTED SERVICES BUDGET FORMULATION 10107.1 To be eligible for PDCS services, a Services My Way participant shall be in receipt of a service authorization for personal care aide services that specifies the amount, duration, and scope of services authorized to b…

10108 RECONSIDERATION PROCESS 10108.1 If DHCF or its designee denies any PDCS services or individual-directed good or service requested in a participant’s PDS budget, the participant may request reconsideration of the denial in accordance with § 10108.2. 10108.2 If the participan…

10109 AUTHORIZED REPRESENTATIVES 10109.1 A Services My Way participant may designate an authorized representative to exercise employer-related responsibilities in the Services My Way program. 10109.2 An authorized representative is an individual who willingly accepts responsibili…

10110 MANDATORY REPORTING 10110.1 All EPD Waiver case managers, authorized representatives, and employees of the VF/EA FMS-Support Broker entity shall be required to report any suspected instance of abuse, neglect, or exploitation of a Services My Way participant to DHCF and Adul…

10111 VOLUNTARY TERMINATION OF PROGRAM PARTICIPATION 10111.1 Services My Way participants may decide at any time to voluntarily terminate their participation in the Services My Way program. 10111.2 A Services My Way participant shall indicate the decision to voluntarily terminate…

10112 INVOLUNTARY TERMINATION OF PROGRAM PARTICIPATION 10112.1 Participant/representative-employers shall be required to comply with all program rules and terms of the Participant/Representative-Employer Agreement and the Participant/Representative-Employer Consent Form executed …

10113 EXPENDITURE SAFEGUARDS 10113.1 DHCF shall implement all safeguards described in this section to prevent premature depletion of Services My Way participants’ PDS budgets and address potential service delivery issues associated with budget underutilization. 10113.2 The Financ…

10199 DEFINITIONS 10199.1 Activities of Daily Living (ADLs) - The ability to bathe, transfer, dress, eat and feed oneself, engage in toileting, and maintain bowel and bladder control (continence). Authorized Representative - An individual who willingly accepts responsibility for …

10200 GENERAL PROVISIONS 10200.1 The purpose of this chapter is to establish standards governing Medicaid reimbursement for Health Home services provided to District Medicaid beneficiaries with multiple chronic conditions. This program shall be known as the “My Health GPS” progra…

10201 ELIGIBILITY CRITERIA 10201.1 Except as set forth in § 10201.2, a Medicaid beneficiary shall be eligible to participate in the My Health GPS program if the beneficiary has current diagnoses of three (3) or more of the following chronic conditions: Asthma; (b) Body mass index…

10202 BENEFICIARY ASSIGNMENT AND ENROLLMENT 10202.1 All beneficiaries who meet the eligibility criteria set forth in § 10201 may participate in the My Health GPS program. 10202.2 A beneficiary shall only be assigned to a single My Health GPS entity at any time in accordance with …

10203 BENEFICIARY DISENROLLMENT 10203.1 DHCF shall disenroll a beneficiary from the My Health GPS program if DHCF determines that the beneficiary no longer meets the eligibility requirements as set forth under § 10201. 10203.2 If DHCF takes action to disenroll an enrolled benefic…

10204 MY HEALTH GPS ENTITY APPLICATION PROCESS 10204.1 The following types of organizations may become My Health GPS entities: (a) Primary care clinical individual practices; (b) Primary care clinical group practices; and (c) Federally Qualified Health Centers. 10204.2 In order t…

10205 MY HEALTH GPS PROVIDER REQUIREMENTS 10205.1 Each My Health GPS provider shall contain an approved interdisciplinary team of practitioners, as described within this Section, embedded within the primary care setting of an organization described in § 10204.1. 10205.2 Each My H…

10206 MY HEALTH GPS SERVICES 10206.1 Each My Health GPS provider shall provide the following services to eligible beneficiaries: Comprehensive Care Management, as described in § 10206.3; Care Coordination, as described in § 10206.4; Health Promotion, as described in § 10206.5; Co…

10207 REIMBURSEMENT 10207.1 DHCF shall reimburse My Health GPS entities for the provision of covered My Health GPS services described in § 10206 using a per-member-per-quarter (PMPQ) payment structure that aligns with the quarters of the calendar year. 10207.2 A My Health GPS ent…

10208 QUALITY REPORTING REQUIREMENTS 10208.1 Each My Health GPS entity shall report to DHCF as outlined in the policy guidance document available at HYPERLINK "https://dhcf.dc.gov/page/my-health-gps-program-forms-and-materials"https://dhcf.dc.gov/page/my-health-gps-program-forms-…

10209 [RESERVED] SOURCE: Final Rulemaking published at 65 DCR 0636 (January 26, 2018); as amended by Final Rulemaking published at 66 DCR 5381 (April 26, 2019); as amended by Final Rulemaking published at 72 DCR 010392 (September 26, 2025). District of Columbia Municipal Regulati…

10210 AUDITS AND REVIEWS 10210.1 DHCF shall perform audits of My Health GPS entities to ensure that Medicaid payments for My Health GPS services are consistent with efficiency, economy, and quality of care, and made in accordance with Federal and District conditions of payment. 1…

10211 MY HEALTH GPS SANCTIONS, WITHDRAWAL AND TERMINATION 10211.1 DHCF may determine at any time during a My Health GPS entity’s enrollment in the program that the entity has failed to meet one (1) or more requirements of program participation, and may request the submission of a…

10299 DEFINITIONS 10299.1 When used in this chapter, the following terms shall have the meanings ascribed: Assigned Beneficiary – An individual who is eligible based on the My Health GPS eligibility criteria and has been designated to a My Health GPS provider. Beneficiary – An in…

10300 GENERAL PROVISIONS 10300.1 The purpose of this chapter is to establish the requirements governing Medicaid reimbursement for Housing Supportive Services (HSS), effective May 1, 2022. 10300.2 In order to be eligible for HSS, beneficiaries shall be subject to the following: M…

10301 PROVIDER CERTIFICATION 10301.1 Each agency seeking to provide HSS shall be certified by DHS and comply with the certification requirements set forth by DHS pursuant to Chapter 74 of Title 29 DCMR. SOURCE: Final Rulemaking published at 69 DCR 006426 (June 3, 2022). District …

10302 PROVIDER SCREENING AND ENROLLMENT 10302.1 Prior to enrolling in Medicaid, each agency seeking to provide HSS services shall first be certified by DHS in accordance with § 10301 of this chapter. Once certified, each agency shall: Be screened and enrolled in Medicaid pursuant…

10303 REIMBURSEMENT 10303.1 DHCF shall reimburse each HSS agency using a single per member per month (PMPM) rate that encompass all HSS services an HSS agency furnishes to each eligible beneficiary within a month. 10303.2 To be eligible for a PMPM payment from DHCF, an HSS agency…

10304 COST SURVEYS, FINANCIAL REVIEWS, AND AUDITS 10304.1 To be reimbursed by DHCF, each HSS agency shall report costs annually to DHCF on a cost survey template designated by DHCF no later than one-hundred and twenty (120) days after the end of the agency’s cost survey period, w…

10305 PROGRAM INTEGRITY AUDITS 10305.1 DHCF’s Division of Program Integrity, or its designee, shall perform ongoing audits to ensure that an HSS agency’s services for which Medicaid payments are made are consistent with programmatic duties, documentation, and reimbursement requir…

10399 DEFINITIONS 10399.1 When used in this chapter, the following words shall have the meanings ascribed: Case Manager – An employee of an HSS agency that furnishes direct HSS services and meets the qualification requirements set forth in Chapter 74 of Title 29 DCMR. Case Manage…

10400 GENERAL PROVISIONS 10400.1 The purpose of this chapter is to establish principles of reimbursement for eligible providers of emergency medical ground transportation services participating in the District of Columbia Medicaid program. 10400.2 Medicaid reimbursement to eligib…

10401 COST-BASED REIMBURSEMENT OF DISTRICT EMERGENCY MEDICAL GROUND TRANSPORTATION SERVICES 10401.1 DHCF will reimburse eligible providers enrolled to provide Medicaid emergency medical ground transportation services in the District of Columbia in accordance with the cost-based r…

10402 INTERIM PAYMENT METHODOLOGY 10402.1 DHCF will provide fee-for-service reimbursement of emergency medical ground transportation services provided to District Medicaid-enrolled beneficiaries to eligible providers in accordance with the reimbursement rates set forth in the Dis…

10403 ELIGIBLE EMERGENCY MEDICAL GROUND TRANSPORTATION SERVICE PROVIDERS 10403.1 To be eligible for cost-based reimbursement, emergency medical ground transportation service providers shall be a part of, owned by, or operated by the District of Columbia government. 10403.2 Emerge…

10404 ALLOWABLE COSTS 10404.1 Allowable costs shall include expenses incurred by the eligible provider in provision of emergency medical ground transportation services as identified in the cost reporting template and audited by DHCF in accordance with the requirements set forth i…