District of Columbia Administrative Code

4240 PROGRAM SERVICES: EAA 4240.1 In order to receive Medicaid reimbursement, in-home modifications for EAA services include, but are not limited to, the following: (a) Installation of ramps and grab-bars or hand-rails; (b) Widening of doorways; (c) Installation of lift systems; …

4241 SPECIFIC PROVIDER REQUIREMENTS: ADULT DAY HEALTH 4241.1 In order to receive Medicaid reimbursement, an adult day health provider under the EPD Waiver shall meet the requirements set forth in Chapter 97 (Adult Day Health Program Services) of Title 29 DCMR, including, but not …

4242 PROGRAM SERVICES: ADULT DAY HEALTH 4242.1 Adult day health services shall encourage adults enrolled in the EPD Waiver to live in the community by offering non-residential medical supports and supervised, therapeutic activities in an integrated community setting, to foster op…

4243 [REPEALED] SOURCE: Final Rulemaking published at 64 DCR 6784 (July 21, 2017); as amended by Final Rulemaking published at 72 DCR 004996 (April 25, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 4243 AUTHORITY: DC-DCMR Section 6(6) of the Departmen…

4244 [REPEALED] SOURCE: Final Rulemaking published at 64 DCR 6784 (July 21, 2017); as amended by Final Rulemaking published at 72 DCR 004996 (April 25, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 4244 AUTHORITY: DC-DCMR Section 6(6) of the Departmen…

4245 [REPEALED] SOURCE: Final Rulemaking published at 64 DCR 6784 (July 21, 2017); as amended by Final Rulemaking published at 72 DCR 004996 (April 25, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 4245 AUTHORITY: DC-DCMR Section 6(6) of the Departmen…

4246 [REPEALED] SOURCE: Final Rulemaking published at 64 DCR 6784 (July 21, 2017); as amended by Final Rulemaking published at 72 DCR 004996 (April 25, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 4246 AUTHORITY: DC-DCMR Section 6(6) of the Departmen…

4247 SPECIFIC PROVIDER REQUIREMENTS: INDIVIDUAL-DIRECTED GOODS AND SERVICES 4247.1 In order to receive Medicaid reimbursement, individual-directed goods and services shall only be provided to EPD Waiver beneficiaries enrolled as participants in the Services My Way program. 4247.2…

4248 PROGRAM SERVICES: INDIVIDUAL-DIRECTED GOODS AND SERVICES 4248.1 Individual-directed goods and services are only available to EPD Waiver beneficiaries who are enrolled as participants in the Services My Way program, and are purchased from the participant’s PDS budget. 4248.2 …

4249 SPECIFIC PROVIDER REQUIREMENTS: PARTICIPANT-DIRECTED COMMUNITY SUPPORT SERVICES 4249.1 Participant Directed Community Support Services (PDCS) services shall only be reimbursed to EPD Waiver beneficiaries enrolled as participants in the Services My Way program. 4249.2 Qualifi…

4250 PROGRAM SERVICES: PARTICIPANT-DIRECTED COMMUNITY SUPPORT SERVICES 4250.1 Medicaid will only reimburse PDCS services for EPD Waiver beneficiaries enrolled as participants in the Services My Way program. 4250.2 In order to receive Medicaid reimbursement, PDCS services shall be…

4251 SPECIFIC PROVIDER REQUIREMENTS: COMMUNITY TRANSITION SERVICES 4251.1 Each case manager providing Community Transition services shall: (a) Work with the beneficiary to identify household items needed to facilitate transition to the community; (b) Work with the vendor to ensur…

4252 PROGRAM SERVICES: COMMUNITY TRANSITION SERVICES 4252.1 Community Transition Services are non-recurring set-up expenses for beneficiaries who are transitioning from an institution or other long term care facility to a more integrated and less restrictive community setting. Al…

4253 TERMINATIONS AND ALTERNATIVE SANCTIONS 4253.1 In order to qualify for Medicaid reimbursement, EPD Waiver Providers shall comply with programmatic requirements as part of its Provider Readiness Review and enrollment. The programmatic requirements include adherence to acceptab…

4254 INCIDENTS AND COMPLAINTS 4254.1 Providers are required to report critical incidents that may threaten the beneficiary’s health or welfare for review and follow-up by DHCF and/or other designated agencies. The critical incidents consist of the following categories: (a) Seriou…

4255 AUDITS AND MONITORING/OVERSIGHT REVIEWS 4255.1 The DHCF’s Division of Program Integrity shall perform ongoing audits to ensure that the provider's services for which Medicaid payments are made are consistent with programmatic duties, documentation, and reimbursement requirem…

4256 APPEAL RIGHTS FOR PROVIDERS AGAINST WHOM A RECOUPMENT IS MADE 4256.1 The provider shall have thirty (30) calendar days from the date of the NPRMO to respond in writing. The response shall be submitted to the DHCF’s Director of the Division of Program Integrity. 4256.2 The pr…

4299 DEFINITIONS When used in this chapter, the following terms and phrases shall have the meanings ascribed below: Abuse - Provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the District Medicaid progr…

4300 GENERAL PROVISIONS 4300.1 The purpose of this Chapter is to establish criteria governing Medicaid eligibility for certain uninsured, low-income women who are diagnosed with breast or cervical cancer and establish conditions of participation for providers of treatment service…

4301 ELIGIBILITY REQUIREMENTS 4301.1 A woman eligible to receive services pursuant to this Chapter shall meet all of the following requirements: (a) Be a resident of the District of Columbia; (b) Be at least 18 years of age, but has not attained the age of 65; (c) Has received a …

4302 PROGRAM SERVICES 4302.1 Each provider shall provide comprehensive breast or cervical cancer treatment, evaluation and management services, consisting of, but not limited to surgery, breast reconstructive surgery, radiation and chemotherapy subject to the conditions set forth…

4303 NEED OF TREATMENT 4303.1 A women is determined to need treatment for breast or cervical cancer, if in the opinion of the women's treating health care professional, the diagnostic evaluation following the clinical screening, indicates that the patient is in need of treatment.…

4304 PROVIDER QUALIFICATIONS 4304.1 Each provider shall furnish the necessary personnel, facilities, equipment, material and supplies to perform comprehensive breast and cervical cancer treatment services as required pursuant to these rules. 4304.2 Each provider shall have a demo…

4305 TREATMENT RECORDS 4305.1 Each provider shall maintain accurate records reflecting treatment, evaluation and management services. The record for each patient shall include, but is not limited to, the following information: (a) General information including the patient's name,…

4399 DEFINITIONS 4399.1 When used in this chapter, the following terms and phrases shall have the meanings ascribed: Breast cancer - All primary, recurrent and metastatic cancers of the breast, including, but not limited to, infiltrating or in situ. Cervical cancer - All primary,…

4400 GENERAL REQUIREMENTS 4400.1 This chapter establishes uniform requirements for transferring money or other things of value to recipients outside the District government, where the Department is authorized to make grants. 4400.2 The Director of the Department of Human Services…

4401 GRANT AVAILABILITY ANNOUNCEMENTS AND APPLICATIONS 4401.1 Except where the grant authority specifies the grantee, the availability of a grant shall be announced by one (1) of the following methods: (a) Publication in a newspaper of general circulation in the District of Colum…

4402 APPLICATION REVIEW 4402.1 A review panel selected by the Department shall review each application to determine if it meets the requirements that apply to the particular grant. 4402.2 The review panel shall advise the Director of all those applications which satisfy the appli…

4403 REVIEW FACTORS 4403.1 The recommendations of the review panel and the award decisions of the Director shall be based on the following criteria: (a) Feasibility of the project; (b) Soundness of research design, statistical technique, and procedures and methodology, if appropr…

4404 DISPOSITION OF PROPOSAL 4404.1 The Director shall make the final selection of the grant award. 4404.2 Based on his or her review, the Director shall do one (1) of the following: (a) Approve the application, in whole or in part, for such amount of funds and subject to such co…

4405 GRANT AGREEMENT 4405.1 Each grant award shall be in the form of a written grant agreement between the Director and the awardee that is consistent with those statutes and regulations that apply to the grant. 4405.2 The grant agreement shall include, but not be limited to, the…

4406 CERTIFICATION OF A DRUG-FREE WORKPLACE 4406.1 By submission of its application, the grantee, if other than an individual, certifies and agrees that with respect to all its employees under the grant it shall, no later than thirty (30) calendar days after grant award (unless a…

4407 FINANCIAL MANAGEMENT BY GRANTEES 4407.1 Each grantee shall make accurate, current, and complete disclosure of the financial results of each project or program in accordance with the financial reporting requirements of the grant agreement. 4407.2 Each grantee shall maintain r…

4408 MONITORING BY GRANTEES 4408.1 Each grantee shall monitor grant and subgrant supported activities by reviewing each program, function or activity to assure that adequate progress is being made towards achieving the goals of the grant or subgrant. 4408.2 Each grantee shall sub…

4409 AUDITS AND DISALLOWANCES 4409.1 Appropriate District or Federal personnel may conduct fiscal and program audits of the grantee. 4409.2 Each grantee shall have an annual audit performed by an auditor who is independent of the staff person who authorizes expenditure of project…

4410 PAYMENT OF FUNDS BY GRANTEE 4410.1 As a condition of each grant awarded, the grantee shall agree to do the following: (a) Repay the District for final audit disallowances within thirty (30) days from receipt of notification by a disallowance letter; and (b) Pay interest at t…

4411 CLOSE-OUT 4411.1 The Grant Officer shall close-out the grant when he or she determines that all applicable administrative actions and all required work of the grant have been completed. 4411.2 Upon termination or close-out of the grant, the Grant Officer shall promptly provi…

4412 RECORD RETENTION AND ACCESS 4412.1 The grantee shall retain all records for a period of at least three (3) years following final close-out of the grant, if no other period is specified in the grant agreement. 4412.2 The grantee shall make all records available to the Directo…

4413 TERMINATION AND SUSPENSION PROCEDURES 4413.1 If a grantee has materially failed to comply with the terms of a grant agreement, the Grant Officer may, after giving reasonable written notice to the grantee, do the following: (a) Suspend the grant in whole or in part; (b) Termi…

4414 INFORMAL DISPUTE RESOLUTION 4414.1 The provisions contained in this section and in § 4415 shall establish an informal procedure for resolution of disputes between the grantee and the Director. 4414.2 The procedure shall apply to the following adverse determinations made by t…

4415 DECISION OF THE DIRECTOR 4415.1 The Director may require informal, non-binding mediation between the parties before issuing a final decision if, due to the nature of the dispute, the Director considers it to be in the best interests of the District. 4415.2 The Director shall…

4499 DEFINITIONS 4499.1 When used in this chapter, the following terms shall have the meanings ascribed: Controlled Substance - a controlled substance in schedules I through V or § 202 of the Controlled Substances Act (21 U.S.C. § 812) and as further defined, in regulation, at 21…

4500 GENERAL PROVISIONS 4500.1 The rules set forth in this chapter establish the conditions of participation for a Federally Qualified Health Center (FQHC) in the Medicaid program. These rules also establish the reimbursement methodology for services rendered to Medicaid benefici…

4501 REIMBURSEMENT 4501.1 Medicaid reimbursement for primary care, behavioral health, and dental services furnished by an FQHC shall be made under: A Prospective Payment System (PPS) as described in Section 4502; or An Alternative Payment Methodology (APM) as described in Section…

4502 PROSPECTIVE PAYMENT SYSTEM 4502.1 Medicaid reimbursement for services furnished on or after January 1, 2001 by an FQHC shall be at a Prospective Payment System (PPS) rate consistent with the requirements set forth in Section 1902(bb) of the Social Security Act and subject to…

4503 ALTERNATIVE PAYMENT METHODOLOGY FOR PRIMARY CARE SERVICES 4503.1 The APM rate for primary care services rendered beginning the effective date of the corresponding SPA by an FQHC shall be determined as described in this section. The APM rate shall be applicable to all sites w…

4504 ALTERNATIVE PAYMENT METHODOLOGY FOR BEHAVIORAL HEALTH SERVICES 4504.1 The APM rate for behavioral health services rendered beginning the effective date of the corresponding SPA by an FQHC shall be determined as described in this section. The APM rate shall be applicable to a…

4505 ALTERNATIVE PAYMENT METHODOLOGY FOR PREVENTIVE AND DIAGNOSTIC DENTAL SERVICES 4505.1 The APM rate for preventive and diagnostic dental services rendered beginning the effective date of the corresponding SPA by an FQHC shall be determined as described in this section. The APM…

4506 ALTERNATIVE PAYMENT METHODOLOGY FOR COMPREHENSIVE DENTAL SERVICES 4506.1 The APM rate for comprehensive dental services rendered by the FQHC on or after the effective date of the corresponding SPA by an FQHC shall be determined in accordance with this section. 4506.2 The APM…

4507 PRIMARY CARE SERVICES 4507.1 Covered primary care services provided by the FQHC shall be limited to the following services: Health services related to family medicine, internal medicine, pediatrics, obstetrics (excluding services related to birth and delivery), and gynecolog…