District of Columbia Administrative Code

599 DEFINITIONS 599.1 When used in this chapter, the following terms and phrases shall have the meanings ascribed: ACEP - the American College of Emergency Physicians. Act - the Emergency Medical Services Act of 2008, effective March 25, 2009 (D.C. law 17-357; D.C. Official Code …

5000 GENERAL PROVISIONS 5000.1 These rules establish the standards and conditions of participation for home care agencies providing Medicaid reimbursable personal care aide (PCA) services under the District of Columbia Medicaid Program’s State Plan for Medical Assistance (Medicai…

5001 PROVIDER QUALIFICATIONS 5001.1 A Provider receiving Medicaid reimbursement for PCA services shall: Be a home care agency licensed pursuant to the requirements for home care agencies as set forth in the Health Care and Community Residence Facility, Hospice and Home Care Licen…

5002 ELIGIBILITY REQUIREMENTS 5002.1 To be eligible to receive PCA services, a Medicaid beneficiary must meet all of the following qualifications: (a) Be unable to independently perform one or more activities of daily living for which PCA services are needed; (b) Be in receipt of…

5003 PCA SERVICE AUTHORIZATION REQUEST AND SUBMISSION 5003.1 Except as provided in Subsection 5003.11, in order to be reimbursed by Medicaid, PCA services shall not be initiated or provided on a continuing basis by a Provider without a PCA Service Authorization from DHCF or its d…

5004 REFERRALS 5004.1 Upon completion of the PCA Service Authorization, DHCF or its designated agent shall make a referral to the beneficiary's choice of a qualified Provider. 5004.2 A referral to a qualified Provider shall not be considered complete unless it includes all of the…

5005 PLAN OF CARE 5005.1 An R.N. employed by the Provider shall conduct an initial face-to-face visit with the beneficiary to develop a plan of care for delivering PCA services no later than seventy-two (72) hours after receiving the referral for services from DHCF or its designa…

5006 PROGRAM REQUIREMENTS 5006.1 PCA services shall be ordered, in writing, by a physician or APRN who is enrolled in the D.C. Medicaid program and has had a prior professional relationship with the beneficiary that included an examination(s) provided in a hospital, primary care …

5007 DENIAL, SUSPENSION, REDUCTION OR TERMINATION OF SERVICES 5007.1 When PCA services are no longer desired by the beneficiary or their authorized representative, each Provider shall discontinue PCA services only after: Giving the beneficiary written notice that meets the requir…

5008 STAFFING 5008.1 Each Provider shall utilize an R.N. to manage and provide supervision to PCAs who are qualified to perform all of the functions described in Subsection 5008.3. 5008.2 Each Provider shall verify that each PCA used to deliver services, regardless of whether the…

5009 PERSONAL CARE AIDE QUALIFICATIONS 5009.1 Each PCA, whether an employee of the Provider or secured through a staffing agency, shall meet the following requirements: Obtain and maintain Home Health Aide certification in accordance with the requirements under Chapter 93 of Titl…

5010 STAFFING AGENCIES 5010.1 A Provider may contract with a licensed staffing agency to secure staff to deliver PCA services. Agreements between the Provider and the staffing agency providing personal care staffing services shall be in writing and include at a minimum, the follo…

5011 INSURANCE 5011.1 Each applicant or Provider shall maintain the following minimum amounts of insurance coverage: Blanket malpractice insurance for all employees in the amount of at least one million dollars ($1,000,000) per incident; General liability insurance covering perso…

5012 ADMINISTRATION 5012.1 NPI numbers for Providers and staffing agencies, and all personnel delivering PCA services shall be included in all Medicaid billings. 5012.2 Each Provider shall have a current organizational chart that clearly describes the organizational structure, ma…

5013 RECORDS 5013.1 Each Provider shall maintain complete and accurate records reflecting the specific PCA services provided to each beneficiary for a service billed. Such records must be: Maintained for a period of at least ten (10) years. If DHCF notifies the provider of an imp…

5014 BENEFICIARY RIGHTS AND RESPONSIBILITIES 5014.1 Each Provider shall develop a written statement of a beneficiary’s rights and responsibilities consistent with the requirements of this section, which shall be given to each beneficiary in advance of receiving services or during…

5015 REIMBURSEMENT 5015.1 Each provider shall comply with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01 et seq.). 5015.2 The current reimbursement rate for covered PCA services is listed in the District Medicaid fee schedule …

5016 AUDITS AND REVIEWS 5016.1 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. 5016.2 The audit process shall routinely be conducted b…

5017 APPEALS FOR PROVIDERS AGAINST WHOM A RECOUPMENT IS MADE 5017.1 The Provider shall have sixty (60) days from the date of the NR to request an administrative review of the NR. The request for administrative review of the NR shall be submitted to “Manager, Division of Program I…

5019 ARPA SUPPLEMENTAL PAYMENT FOR PERSONAL CARE AIDES 5019.1 In accordance with Section 9817 of the American Rescue Plan Act of 2021, approved March 11, 2021 (Pub. L. 117-2; 135 Stat. 4), supplemental payments shall be made to home health agencies providing personal care aide se…

5099 DEFINITIONS When used in this chapter, the following terms and phrases shall have the meanings ascribed below: Activities of Daily Living - The ability to bathe, transfer, dress, eat and feed oneself, engage in toileting, and maintain bowel and bladder control (continence). …

5200 GENERAL PROVISIONS 5200.1 The purpose of this Chapter is to establish standards governing Medicaid reimbursement for Mental Health Rehabilitative Services (MHRS) provided by MHRS providers certified by the Department of Mental Health (DMH). 5200.2 DMH and each MHRS provider …

5201 PROGRAM SERVICES 5201.1 Mental Health Rehabilitative Services (MHRS) shall include the following services: Screening, Assessment, and Diagnosis; Medication Management; Counseling/Therapy; Community Support; Crisis/Emergency Services; Clinical Care Coordination; Rehabilitatio…

5202 SCREENING, ASSESSMENT, AND DIAGNOSTICS 5202.1 Screening, Assessment, and Diagnostic Services include the following services: Screening; Initial Assessment; Comprehensive Diagnostic Assessment; and Ongoing Diagnostic Assessment. 5202.2 Services shall be reimbursed as follows:…

5203 MEDICATION MANAGEMENT Medication Management services shall: Be billed per occurrence; Not be billed on the same day as IDT; Not be billed while a consumer is enrolled in ACT, unless the service is rendered by another MHRS provider and is either: During the first thirty (30) …

5204 COUNSELING/THERAPY 5204.1 Counseling/Therapy services shall include: Individual Counseling/Therapy; Group Counseling/Therapy; and Family Counseling/Therapy. 5204.2 Counseling/Therapy services shall: Consist of a face-to-face encounter; Be reimbursed on a per-occurrence basis…

5205 COMMUNITY SUPPORT 5205.1 Community Support services include: Participation in the development and implementation of a consumer’s individualized Plan of Care; Mental health interventions to increase and improve independent and community living skills, social skills, and suppo…

5206 CRISIS/EMERGENCY SERVICES 5206.1 Crisis/Emergency Services shall: Be provided in fifteen (15) minute units; Be authorized and billed in accordance with requirements set forth in Chapter 34 of Title 22-A DCMR; and Be provided in a DBH-certified MHRS provider’s service site or…

5207 REHABILITATION DAY SERVICES 5207.1 Rehabilitation Day Services shall include: Education on self-management of symptoms, medications and side effects; Identification of rehabilitation preferences; Setting rehabilitation goals; and (d) Skills teaching and development. 5207.2 R…

5208 INTENSIVE DAY TREATMENT 5208.1 Intensive Day Treatment (“IDT”) services and interventions consist of structured individual and group activities and therapies that are planned, goal-oriented, and provided under active psychiatric supervision. 5208.2 IDT shall: Be billed in on…

5209 COMMUNITY BASED INTERVENTION 5209.1 Community Based Intervention (“CBI”) services shall: Be provided in fifteen (15) minute units; Require prior authorization; Not be billed on the same day as Counseling/Therapy or IDT; Not be billed on the same day as Community Support, unl…

5210 ASSERTIVE COMMUNITY TREATMENT 5210.1 Assertive Community Treatment (“ACT”) services shall include: Completion of comprehensive and ongoing assessments and development and updating of a self-care-oriented Plan of Care (if a current and effective one does not already exist); M…

5211 PSYCHOSOCIAL REHABILITATION SERVICES/CLUBHOUSE 5211.1 Psychosocial Rehabilitation (“Clubhouse”) services utilize behavioral, cognitive, and supportive interventions to assist individuals with mental health diagnoses to develop social networking, independent living, budgeting…

5212 CHILD-PARENT PSYCHOTHERAPY 5212.1 Child-Parent Psychotherapy (“CPP”) is a relationship-based treatment intervention to address children’s exposure to trauma or maltreatment. CPP sessions are conjoint with the child’s parent(s) or caregiver(s) and focus on improving the child…

5213 TRAUMA RECOVERY AND EMPOWERMENT SERVICES 5213.1 Trauma Recovery and Empowerment Services is a structured group therapy intervention for individuals who have survived trauma and have substance use disorders, mental health conditions, or both. 5213.2 Trauma Recovery and Empowe…

5214 TRAUMA SYSTEMS THERAPY 5214.1 Trauma Systems Therapy (“TST”) is a comprehensive, phase-based model for treating traumatic stress in children and adolescents that adds to individually-based approaches by specifically addressing the child’s social environment and/or system of …

5215 TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY 5215.1 Trauma-Focused Cognitive Behavioral Therapy (“TF-CBT”) is a psychotherapeutic intervention for individuals ages four (4) to eighteen (18), designed to address significant emotional and behavioral difficulties related to trau…

5216 CLINICAL CARE COORDINATION 5216.1 Clinical Care Coordination (“CCC”) is the coordination of care between the behavioral health clinician and the clinical personnel of an external provider (e.g., primary care, another behavioral health provider, or hospital). 5216.2 CCC shall…

5217 FUNCTIONAL FAMILY THERAPY 5217.1 Functional Family Therapy (“FFT”) is a short-term, family-based therapeutic intervention for youth ages eleven (11) to eighteen (18) who: Have a documented history of moderate to serious behavioral problems; Exhibit significant externalizing …

5218 INTENSIVE CARE COORDINATION 5218.1 Intensive Care Coordination (“ICC”) is a comprehensive, holistic, and youth and family-driven approach to case management activities for children and youth experiencing behavioral health challenges. 5218.2 ICC is covered as Targeted Case Ma…

5219 MULTI-SYSTEMIC THERAPY 5219.1 Multi-systemic Therapy (MST) is an intensive program for youth ages twelve (12) to seventeen (17) experiencing out of home placement. 5219.2 Multi-systemic Therapy shall: Be billed in fifteen (15) minute units; Require prior authorization; and B…

5220 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 012836 (October 21, 2022); as amended by Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 5220 AUTHORITY: DC-DCMR Pursuant to the author…

5221 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 012836 (October 21, 2022); as amended by Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 5221 AUTHORITY: DC-DCMR Pursuant to the author…

5222 [RESERVED] SOURCE: Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 5222 AUTHORITY: DC-DCMR Pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal …

5223 [RESERVED] SOURCE: Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 5223 AUTHORITY: DC-DCMR Pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal …

5224 [RESERVED] SOURCE: Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 5224 AUTHORITY: DC-DCMR Pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal …

5225 [RESERVED] SOURCE: Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 5225 AUTHORITY: DC-DCMR Pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal …

5226 [RESERVED] SOURCE: Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 5226 AUTHORITY: DC-DCMR Pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal …