District of Columbia Administrative Code

11199 DEFINITIONS 11199.1 Authorized Representative - An individual who willingly accepts responsibility for performing employer and PDS budget management tasks that a participant is unable to perform without the assistance of a representative, and who has been designated by the …

11200 GENERAL PROVISIONS 11200.1 These rules establish the standards and conditions for Medicaid reimbursement of doula services under the District of Columbia Medicaid program. 11200.2 The provisions of this chapter govern conditions of participation for providers of doula servi…

11201 SCOPE OF SERVICES 11201.1 Doula services are provided during the perinatal and postpartum periods of a beneficiary’s pregnancy and provide support to the birthing parent throughout the pregnancy and postpartum periods to improve maternal health outcomes. 11201.2 The followi…

11202 PROVIDER SCREENING AND ENROLLMENT 11202.1 To provide Medicaid-reimbursable doula services an individual providing doula services must: Be at least eighteen (18) years of age; Possess a high school diploma or equivalent; Possess a current certification from a doula-certifyin…

11203 REIMBURSEMENT 11203.1 DHCF shall establish fees and reimbursement for only those doula services outlined in Subsection 11201.2. Reimbursement for doula services shall be made according to the District of Columbia Medicaid fee schedule available online at http://www.dc-medic…

11299 DEFINITIONS 11299.1 For the purposes of this Chapter, the following terms shall have the meanings ascribed: Birthing parent – the individual giving birth. Cesarean section- a surgical procedure in which a fetus is delivered through an incision in the birthing parent’s abdom…

11400 PURPOSE AND APPLICATION 11400.1 The purpose of the Department’s Peer Case Management Institute (PCMI) is to train individuals with lived experience of homelessness to serve as case managers at homeless services agencies that are providers in the District’s Continuum of Care…

11401 GENERAL PROVISIONS 11401.1 The Department shall administer the PCMI, including the issuance of Peer Case Manager Certifications, determining the requirements for the Peer Case Manager Certifications, and establishing how CoC agencies shall or may use the certification in hi…

11402 PEER CASE MANAGEMENT INSTITUTE (PCMI) — ELIGIBLITY, APPLICATION, AND SELECTION 11402.1 In order to be eligible to participate in the Peer Case Management Institute, an applicant shall be: (a) A District resident; (b) At least eighteen (18) years of age; and (c) Either: (1) …

11403 PCMI — TRAINING REQUIREMENTS 11403.1 To qualify for the Peer Case Manager Certification, a PCMI participant shall first successfully complete at least one hundred twenty hours (120) of required classroom training. 11403.2 The PCMI classroom training shall be structured to p…

11404 PCMI — PRACTICUM REQUIREMENT 11404.1 To qualify for the Peer Case Management Certification, a PCMI participant shall also successfully complete a field practicum. 11404.2 The purpose of the PCMI field practicum is to provide participants with an opportunity to apply the ski…

11405 PCMI — DISMISSAL 11405.1 A participant who does not receive a passing score on the final evaluation of their initial practicum and does not request to complete a second practicum placement shall be dismissed from the program. 11405.2 If a participant requests a second pract…

11406 PEER CASE MANAGER CERTIFICATION 11406.1 A PCMI participant who successfully completes both the classroom-based training and the field practicum shall be eligible to receive the Peer Case Manager Certification. 11406.2 After verifying that a PCMI participant has met the requ…

11499 DEFINITIONS 11499.1 The terms in this chapter shall have the definitions set forth in Section 2 of the Act (D.C. Official Code § 4-751.01). 11499.2 In addition, for the purposes of this chapter, the following terms shall have the meaning ascribed: Act – the Homeless Service…

1200 GENERAL PROVISIONS 1200.1 The Department of Youth Rehabilitation Services (DYRS), shall administer community service programs for delinquents and persons-in-need-of-supervision (PINS) who are committed to the legal custody of DYRS by the D.C. Superior Court. 1200.2 The provi…

1201 COMMUNITY RELEASE AGREEMENTS 1201.1 Department of Youth Rehabilitation Services (DYRS) shall place youth in a community status after a determination that he or she will benefit most from the least restrictive environment consistent with public safety, and with D.C. Official …

1202 RESCISSION OF COMMUNITY PLACEMENT STATUS 1202.1 DYRS shall hold youth, who have entered into a Community Release Agreement, accountable for behavior contrary to public safety or the terms of the Community Release Agreement. 1202.2 DYRS shall initiate a review of the youth’s …

1203 COMMUNITY STATUS REVIEW 1203.1 The DYRS Case Worker responsible for the youth who is arrested and charged with any criminal offense cited in Subsection 1202.2, shall process the documentation for a Community Status Review Hearing within three (3) business days of notificatio…

1204 EMERGENCY REMOVALS 1204.1 The following procedures shall apply to Emergency Removals Without Youth’s Consent: (a) The DYRS Case Worker shall remove the youth from his or her placement, and place the youth in a secure DYRS facility, emergency shelter, in-patient drug treatmen…

1205 RECOMMENDATION OF CASE MANAGEMENT DIVISION PROGRAM MANAGER 1205.1 A Case Management Division Program Manager or designee shall review the request for Community Status Review Hearing and accompanying documents, and make an independent decision regarding the need for a hearing…

1206 RECOMMENDATION OF DYRS CASE MANAGEMENT DIVISION 1206.1 The final decision to schedule a Community Status Review Hearing shall be made by the Chief of Committed Services or designee. After receiving the recommendation from the Case Management Division Program Manager or desig…

1207 NOTICE OF COMMUNITY STATUS REVIEW HEARING 1207.1 After receiving the recommendation of the Chief of Committed Services or designee, an official notice of the time, place and location of the Community Status Review Hearing shall be sent to the youth, the youth's parent(s) or …

1208 FAILURE TO APPEAR AT A HEARING AND ABSCONDENCE 1208.1 After receiving notice, in accordance with § 1207, if the youth fails to appear at the stated time and place, for a Community Status Review Hearing the DYRS Care Manager responsible for the youth shall do the following: (…

1209 HEARING UPON YOUTH’S RETURN FROM ABSCONDENCE 1209.1 In those cases where the youth was not present at the scheduled Community Status Review Hearing and the hearing proceeded in his or her absence, the youth may request a second hearing within seventy-two (72) hours of his or…

1210 COMMUNITY STATUS REVIEW HEARINGS 1210.1 All hearings shall be held at the time, place and location shown on the notice to appear before the Community Status Review Hearing form, unless otherwise notified. 1210.2 The Community Status Review Panel shall consist of three (3) DY…

1211 HEARING DECISION, DISPOSITION AND APPEAL 1211.1 All hearing decisions shall be read to the youth in the hearing room and the Chair of the Community Status Review Panel or designee shall provide the written findings to the youth, his or her parent(s) or guardian(s), and attor…

1299 DEFINITION 1299.1 As used in this chapter, the following terms and phrases shall have the meanings ascribed: “Business day” - a day of the week consisting of Monday through Friday, and excludes Saturday, Sunday, any legal holiday, or inclement weather that results in a day i…

12201 SCOPE 12201.01 The purpose of this chapter is to regulate the Child Support Lien Program (CSLP). The program will identify and levy settlement funds belonging to child support obligors to satisfy their support arrearages. The Child Support Services Division (CSSD) of the Of…

12202 SETTLEMENT FUNDS SUBJECT TO LIEN 12202.01 CSSD shall submit District of Columbia Child Support Enforcement System (DCCSES) files to the Child Support Lien Network (CSLN) to identify obligors with overdue support who are entitled to settlement funds from insurers and meet th…

12203 LIEN CRITERIA 12203.1 Settlement funds identified through a CSSD data match with CSLN shall be subject to the filing of a lien when: (a) There is an active child support case; (b) The child support order has accumulated arrears greater than or equal to five hundred dollars …

12204 FILING THE LIEN 12204.1 If a CSLN data match establishes that an obligor is entitled to settlement funds on a personal injury or workers’ compensation claim and CSSD determines that these funds are subject to a lien under § 12203, CSSD shall file the lien with the Recorder …

12205 LEVY PROCESS 12205.1 Once CSSD has filed the Lien with the Recorder of Deeds, CSSD shall: Serve the insurer with a Notice of Lien, which shall indicate the amount of arrears owed by the obligor and direct the insurer to: Levy the funds in the amount of arrears owed by the o…

12206 AGENCY REVIEW 12206.1 An obligor whose funds are subject to a lien may request an agency review within fifteen (15) days from the date of the Notice of Lien. The obligor may request the agency review by informing CSSD of his or her objections to the Notice of Lien by phone,…

12207 ADMINISTRATIVE HEARING 12207.1 Regardless of whether the obligor has sought agency review of the Notice of Lien, the obligor may seek legal review of the agency’s action by requesting an administrative hearing with OAH within sixty-five (65) days from the date of the Notice…

12208 APPEAL PROCEDURE 12208.1 The obligor may seek judicial review of the administrative hearing decision at the D.C. Court of Appeals in accordance with section 11 of the District of Columbia Administrative Procedure Act, approved October 21, 1968 (82 Stat. 1209; D.C. Official …

12209 CONFIDENTIALITY CSSD shall maintain the confidentiality of information and records concerning an obligor’s financial information and shall only release information or records as permitted by applicable provisions of District or federal law. SOURCE: Final Rulemaking publishe…

12299 DEFINITIONS The following terms and phrases shall have the meanings ascribed here: Arrears – past due child support payments. Child Support Lien Network (CSLN) – a national database that is matched daily with personal injury and workers’ compensation claims registered by in…

1300 GENERAL PROVISIONS 1300.1 This chapter governs the administrative actions the Department may take with respect to providers who participate in the District of Columbia Medicaid Program. The administrative actions are as follows: (a) Exclusion, termination and/or suspension o…

1301 EXCLUSION OF MEDICAID PROVIDER FROM REIMBURSEMENT 1301.1 For purposes of this chapter, "exclusion" means that items or services furnished by a specific provider who has defrauded or abused the Medicaid Program shall not be reimbursed under Medicaid. 1301.2 The Director shall…

1302 TERMINATION OF MEDICAID PROVIDER AGREEMENT 1302.1 The Director may terminate a provider agreement under Medicaid if he or she determines that at any time prior to or after the effective date of these rules, the provider has done any one (1) of the following: (a) He or she en…

1303 NOTICE OF PROPOSED EXCLUSION OR TERMINATION 1303.1 If the Director proposes to deny reimbursement to a provider under §1301 or to terminate a provider agreement pursuant to §1302, he or she shall send written notice of intent and the reasons for the proposed exclusion or ter…

1304 SUSPENSION FOR CONVICTION OF PROGRAM RELATED OFFENSE 1304.1 For the purposes of this section, the term "suspension" means that items or services furnished by a specified provider who has been convicted of a program related offense in a Federal, District of Columbia, State or…

1305 SUSPENSION OF MEDICAID PAYMENTS FOR OVERPAYMENTS 1305.1 Payments otherwise authorized to be made to a provider under the District of Columbia Medicaid Program may be suspended, in whole or in part, by the Director when either of the following occurs: (a) The Director has det…

1306 SUSPENSION OF MEDICAID PAYMENTS FOR OVERPAYMENT-PROCEEDING 1306.1 Whenever the Director has determined that a suspension of payments under §1305 shall be put into effect with respect to a provider, the Director shall notify the provider of his or her intention to suspend pay…

1307 SUSPENSION OF MEDICAID PAYMENTS FOR OVERPAYMENT-EVIDENCE AND NOTICE 1307.1 When the provider, pursuant to §1306, submits a statement, the Director shall consider the statement including any pertinent evidence submitted together with any other material bearing upon the case a…

1308 SUBSEQUENT ACTION BY THE DIRECTOR 1308.1 When a suspension is put into effect by reason of §1306.2, the suspension shall remain in effect until one (1) of the following occurs: (a) The overpayment is liquidated; (b) The Director enters into an agreement with the provider for…

1309 PROCEDURES REGARDING DETERMINATION OF PROGRAM REIMBURSEMENT BASED UPON COST REPORTS 1309.1 The procedures contained in this section through §1311 govern DHS determinations of Medicaid program reimbursement due to those Medicaid providers who are reimbursed based upon cost re…

1310 EFFECT OF DIRECTOR'S DETERMINATION 1310.1 The determination by the Director shall be final and binding on the provider submitting a cost report for program reimbursement unless either of the following occurs: (a) The Director revises his or her determination on the basis of …

1311 RIGHT TO A HEARING 1311.1 The provider who has been furnished a notice of amount of program reimbursement may request a hearing, if he or she is dissatisfied with the Director's determination contained in the notice, by filing a notice of appeal with the D.C. Board of Appeal…

1312 NOTICE OF SANCTIONS TO OTHER PARTIES 1312.1 When a provider has been excluded, terminated or suspended pursuant to §1304, the Director shall notify the following parties regarding any action taken and the effective date: (a) HCFA; and (b) The following, as appropriate: (1) M…