District of Columbia Administrative Code

10405 CALCULATION OF RECONCILED COSTS 10405.1 Reconciled costs shall be equal to an eligible provider’s audited allowable costs less the sum of Medicaid fee-for-service payments and other sources of reimbursement. 10405.2 DHCF shall apportion an eligible provider’s allowable cost…

10406 COST REPORTING, AUDITS, AND RECORD MAINTENANCE 10406.1 Eligible providers shall submit an annual cost report to DHCF within one hundred eighty days (180) days of the close of the provider's cost reporting period, which shall be concurrent with the District of Columbia gover…

10407 ACCESS TO RECORDS 10407.1 Eligible providers shall allow appropriate DHCF personnel, representatives of the United States Department of Health and Human Services and other authorized agents or officials of the District of Columbia government and federal government full acce…

10408 APPEALS 10408.1 At the conclusion of each audit, an eligible provider shall receive an audited cost report including a description of each audit adjustment and the reason for each adjustment. 10408.2 Within thirty (30) calendar days of the date of receipt of the audited cos…

10499 DEFINITIONS 10499.1 When used in this chapter, the following terms shall have the meanings ascribed: Accrual Method of Accounting - A method of accounting where revenue is recorded in the period earned, regardless of when collected and expenses are recorded in the period in…

10500 COMMUNITY RESTROOM INCENTIVE PILOT PROGRAM 10500.1 The Department shall implement and administer the Community Restroom Incentive Pilot Program (“Pilot Program”) established pursuant to section 4 of the Public Restroom Facilities Installation and Promotion Act of 2018 (the …

10600 BEHAVIORAL HEALTH STABILIZATION 10600.1 Behavioral Health Stabilization services address an unplanned behavioral health crisis event that does not require hospitalization. 10600.2 Effective January 1, 2022, Medicaid reimbursable Behavioral Health Stabilization services shal…

10601 COMPREHENSIVE PSYCHIATRIC EMERGENCY PROGRAM 10601.1 Comprehensive Psychiatric Emergency Program (CPEP) services are services provided on an emergent basis to individuals experiencing a behavioral health crisis, as defined in Chapter 80 of Title 22-A of the DCMR. 10601.2 CPE…

10602 ADULT MOBILE CRISIS AND OUTREACH 10602.1 Adult mobile crisis and outreach services are acute behavioral health crisis interventions and behavioral health outreach services intended to minimize the individual’s involvement with law enforcement, emergency room use, or hospita…

10603 YOUTH MOBILE CRISIS INTERVENTION 10603.1 Youth Mobile Crisis Intervention services are services that engage children and youth who may be experiencing a behavioral health crisis, as defined in Chapter 80 of Title 22-A of the DCMR. 10603.2 Youth Mobile Crisis Intervention se…

10604 PSYCHIATRIC CRISIS STABILIZATION 10604.1 Psychiatric crisis stabilization services are residential services that offer therapeutic, community-based, home-like treatment for individuals living in the community who need support to ameliorate psychiatric symptoms and, based up…

10700 SUPPORTED EMPLOYMENT SERVICES FOR INDIVIDUALS WITH SUBSTANCE USE DISORDER 10700.1 Supported employment services for beneficiaries with a Substance Use Disorder (SUD) shall: (a) Provide ongoing work-based vocational assessments, job development, job coaching, treatment team …

10701 SUPPORTED EMPLOYMENT SERVICES FOR INDIVIDUALS WITH SERIOUS MENTAL ILLNESS 10701.1 Supported employment services for individuals with serious mental illness shall: (a) Provide ongoing work-based vocational assessment, job development, job coaching, treatment team coordinatio…

10800 BEHAVIORAL HEALTH TRANSITION PLANNING SERVICES 10800.1 Behavioral Health Transition Planning services are services for Medicaid beneficiaries stepping down from certain institutional treatment settings. Behavioral Health Transition Planning services identify needed treatmen…

10900 GENERAL PROVISIONS 10900.1 The District of Columbia (District) provides medical assistance to pregnant women who meet both financial and non-financial requirements under the provisions of this Chapter through a program entitled the “From Conception to End of Pregnancy (FCEP…

10901 APPLICATION AND REDETERMINATION Pregnant individuals enrolled in the Alliance program or ICP who are eligible for FCEP CHIP under this Chapter, and individuals reporting a change of circumstances based on pregnancy or otherwise notifying the Department of their desire to re…

10902 RESIDENCY 10902.1 An individual shall be a resident of the District and document such residency as a condition of FCEP CHIP eligibility. 10902.2 In verifying an applicant’s residency, the Department shall accept any of the forms identified in §§ 10902.3 and 10902.4 below. 1…

10903 VERIFICATION OF NON-FINANCIAL ELIGIBILITY FACTORS 10903.1 The Department shall verify the non-financial eligibility factors necessary for an eligibility determination at the time of application. The Department may also periodically review and request verification of non-fin…

10904 FINANCIAL ELIGIBILITY REQUIREMENTS 10904.1 For the purposes of determining an applicant’s eligibility under § 10900.3, the Department shall apply the modified adjusted gross income (MAGI) methodology rules in accordance with § 9506 of Title 29 DCMR. SOURCE: Final Rulemaking…

10905 ENROLLMENT AND SERVICES 10905.1 Individuals enrolled in the Alliance or ICP who are determined eligible for FCEP CHIP shall be automatically enrolled into an FCEP CHIP managed care organization (MCO), in accordance with § 10905.6, and shall be considered enrolled on the fir…

10906 DISENROLLMENT 10906.1 Beneficiaries shall have the right to disenroll from their MCO upon request, for the reasons described under § 10906.4 and pursuant to the requirements under 42 C.F.R. § 438.56(c). 10906.2 An MCO may request beneficiary disenrollment in accordance with…

10907 INMATES 10907.1 If a beneficiary becomes an inmate, the Department shall suspend capitation payments to the MCO in which the beneficiary is enrolled for the duration of the beneficiary’s incarceration. FCEP CHIP participation and capitation payments for a beneficiary may be…

10908 NOTICE AND FAIR HEARING RIGHTS The Department shall provide timely notice of eligibility and enrollment determinations and the right to appeal the determination to applicants and beneficiaries of FCEP CHIP consistent with the requirements set forth in federal and District l…

10999 DEFINITIONS When used in this chapter, the following terms and phrases shall have the following meanings: Applicant - an individual who is seeking an eligibility determination for medical assistance in the FCEP CHIP through an application submission. Authorized representati…

1100 ESTABLISHMENT 1100.1 The Office of Energy shall administer the Complementary Energy Assistance Program (CEAP) which provides energy assistance Grants to needy households referred by the Vocational Rehabilitation Program, the Subsidized Adoption Program, the Foster Care Progr…

1101 ELIGIBILITY 1101.1 Persons shall be eligible to initially receive assistance who meet the following requirements: (a) Referred by Vocational Rehabilitation after employment; have been referred by the AFDC program after denial or termination due to earned income; have been re…

1102 ASSISTANCE 1102.1 Assistance shall be provided in the form of monthly checks mailed to qualified recipients. 1102.2 Except as otherwise provided to § 1102.3 the amount of assistance awarded to a recipient shall be calculated to reflect the average District Of Columbia reside…

1103 APPLICATION PROCEDURES 1103.1 All clients, those referred and other needy District residents, shall receive written information regarding the eligibility requirements and the application procedures for CEAP. 1103.2 Applicants seeking assistance under CEAP shall complete a wr…

1104 TERMINATION AND REDUCTION PROCEDURES 1104.1 Participants shall be terminated from the CEAP automatically upon the determination that they are no longer eligible based on the requirements set forth in §§ 1101.1 and 1101.2 of these regulations. 1104.2 Advance notice of termina…

1105 FAIR HEARING 1105.1 Applicants or recipients may request orally, or in writing a Fair Hearing from the D.C. Energy Office, for any of the following reasons: (a) If the application is denied; (b) If the application is neither denied nor approved within forty-five (45) days of…

11100 GENERAL PROVISIONS 11100.1 The My Life, My Way program shall be established as a Medicaid participant-directed services (PDS) program in the District of Columbia to afford participants enrolled in the Home and Community-Based Services (HCBS) Waiver for Individual and Family…

11101 OUTREACH AND ENROLLMENT 11101.1 Both current and newly enrolled IFS Waiver participants who meet the requirements of § 11100.2 may elect to enroll in the My Life, My Way program. 11101.2 The Department on Disability Services (DDS) staff provide information regarding self-di…

11102 COMPANION SERVICES: SERVICE DESCRIPTION 11102.1 Companion services provide non-medical assistance and supervision to support a participant’s goals, desires, and needs as identified in the participant’s ISP and reflected in their Person-Centered Thinking and Discovery tools.…

11103 COMPANION SERVICES: PROVIDER REQUIREMENTS 11103.1 Qualified PDWs shall provide PDS as employees of My Life, My Way program participants. 11103.2 PDS may be provided by family members and individuals other than a participant's spouse, other legally responsible relative, or c…

11104 INDIVIDUALIZED DAY SUPPORTS: SERVICE DESCRIPTION 11104.1 In order to receive Medicaid reimbursement for individualized day supports services, the participant’s Individual Support Plan (ISP) and Plan of Care, must document that the need for the service is consistent with the…

11105 INDIVIDUALIZED DAY SUPPORTS: PROVIDER REQUIREMENTS 11105.1 Qualified PDWs shall provide PDS as employees of My Life, My Way program participants. 11105.2 Parents of adult children may provide PDS. 11105.3 A legally responsible relative does not include parents of adult chil…

11106 IN-HOME SUPPORTS: SERVICE DESCRIPTION 11106.1 To be reimbursed by Medicaid, in-home supports are services that are only provided to people enrolled in the IFS Waiver program who have an assessed need for assistance: With acquisition, retention or improvement in skills relat…

11107 IN-HOME SUPPORTS: PROVIDER REQUIREMENTS 11107.1 Qualified PDWs shall provide in-home support services as employees of My, Life My Way participants. In-home support services shall be authorized in accordance with the following provider requirements: The Department on Disabil…

11108 RESPITE SERVICES: SERVICE DESCRIPTION 11108.1 Respite services provide relief to a participant’s family or primary caregiver to enable them to participate in scheduled or unscheduled time away from the participant, and to prevent gaps in the delivery of the participant’s se…

11109 RESPITE SERVICES: PROVIDER REQUIREMENTS 11109.1 All PDWs shall comply with the requirements under Section 9006 (Records and Confidentiality of Information of Chapter 90 of Title 29 DCMR, except that no quarterly report is required for respite hourly services. 11109.2 To be …

11110 INDIVIDUAL-DIRECTED GOODS AND SERVICES: SERVICE DESCRIPTION 11110.1 In order to receive Medicaid reimbursement, individual-directed goods and services shall only be provided to IFS Waiver participants who are enrolled in the My Life, My Way program and are purchased from th…

11111 INDIVIDUAL-DIRECTED GOODS AND SERVICES: PROVIDER REQUIREMENTS 11111.1 Individual-directed goods and services shall be provided only to IFS Waiver participants enrolled as participants in the My Life, My Way program. 11111.2 All individuals and vendors providing individual-d…

11112 VENDOR FISCAL/EMPLOYER AGENT FINANCIAL MANAGEMENT SERVICES-SUPPORT BROKER ENTITY FUNCTIONS 11112.1 My Life, My Way program participants shall receive financial management services and information and assistance services through the VF/EA FMS-Support Broker entity selected b…

11113 PARTICIPANT-DIRECTED SERVICES BUDGET FORMULATION 11113.1 To be eligible for PDS, a participant shall be in receipt of a service authorization for in-home supports, individualized day supports, companion services, respite daily services, and/or individual-directed goods and …

11114 RECONSIDERATION PROCESS 11114.1 If DDS denies any PDS or individual-directed goods or services requested in a participant's PDS budget, the participant may request reconsideration of the denial in accordance with § 11114.2. 11114.2 If the participant wishes to request recon…

11115 AUTHORIZED REPRESENTATIVES 11115.1 A My Life, My Way program participant may designate an authorized representative to exercise employer-related responsibilities in the My Life, My Way program. 11115.2 An authorized representative is an individual who willingly accepts resp…

11116 MANDATORY REPORTING 11116.1 All service coordinators, 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 My Life, My Way program participant to DDS and A…

11117 VOLUNTARY TERMINATION OF PROGRAM PARTICIPATION 11117.1 My Life, My Way program participants may decide at any time to voluntarily terminate their participation in the My Life, My Way program. 11117.2 A My Life, My Way program participant shall indicate the decision to volun…

11118 INVOLUNTARY TERMINATION OF PROGRAM PARTICIPATION 11118.1 Participant/ representative-employers shall be required to comply with all program rules and terms of the Participant/Representative-Employer Agreement executed at the time of enrollment in the My Life, My Way program…

11119 EXPENDITURE SAFEGUARDS 11119.1 DDS shall implement all safeguards described in this section to prevent premature depletion of My Life, My Way program participants' PDS budgets and address potential service delivery issues associated with budget underutilization. 11119.2 The…