District of Columbia Administrative Code

6343 TRANSPORTATION SERVICES 6343.1 An independent living program shall provide or arrange for transportation necessary to implement each resident’s service plan, including assisting the resident to access public transportation. 6343.2 A vehicle provided by an independent living …

6344 RECREATIONAL ACTIVITIES 6344.1 An independent living program shall develop and follow a written plan for providing recreational activities adequate to meet each resident's needs, including: (a) Sufficient supervised, organized or structured individual and group recreational …

6345 RESIDENTS' COUNCIL 6345.1 An independent living program shall establish and maintain a residents' council. 6345.2 The purpose of the residents' counsel is to make recommendations to the independent living program to improve the quality of the independent living program and t…

6346 VISITATION AND CONTACT 6346.1 An independent living program shall develop and follow written rules for reasonable visitation, mail, and telephone contact between residents and the residents' families, friends, attorneys, and guardians ad litem, which shall be consistent with…

6347 BEHAVIOR MANAGEMENT AND DISCIPLINE 6347.1 An independent living program shall establish behavior management strategies to provide rewards and praise for appropriate behavior as well as negative consequences for inappropriate behavior. Behavior management strategies may inclu…

6348 DISCHARGE 6348.1 An independent living program may not discharge a resident without the agreement of the contracting entity. 6348.2 An independent living program shall prepare a discharge plan whenever a resident is discharged. 6348.3 The discharge plan shall include: (a) Th…

6349 APPEAL PROCEDURE 6349.1 A person aggrieved by a decision of CFSA to deny, suspend, or revoke a license or the renewal of a license may appeal the decision in accordance with 29 DCMR Chapter 59. SOURCE: Final Rulemaking published at 49 DCR 1591 (February 22, 2002). AUTHORITY:…

6399 DEFINITIONS 6399.1 The following terms and phrases shall have the meanings described: Administrator - The independent living program staff member responsible for the operation of the independent living program or that person's designee. Admission - The administrative process…

6400 GENERAL PROVISIONS 6400.1 The purpose of this Chapter is to establish standards governing the administration of the Medicaid Section 1115 Health Care Reform Demonstration for individuals with HIV (the "Demonstration Project"), as authorized under §1115 of the Social Security…

6401 ELIGIBILITY REQUIREMENTS 6401.1 Each individual eligible to receive services shall meet all of the following requirements: (a) Is a District of Columbia resident: (b) Has a gross income at or below one hundred percent (100%) of the Federal Poverty Level (FPL); (c) Has resour…

6403 INCOME REQUIREMENTS 6403.1 Each applicant shall provide documentation of income that shall include the following: (a) For a gross income determination, each applicant shall provide evidence of any of the following documentation that is applicable: (1) Social Security cash be…

6404 ENROLLMENT PROCESS 6404.1 Each applicant shall complete a single application that shall be signed and dated. Application forms shall be made available and submitted to the District's HIV/AIDS Administration (HAA) for review and approval. 6404.2 Each applicant shall obtain an…

6405 RECIPIENT PROVIDER ASSISTANCE 6405.1 A Demonstration Project recipient shall have the freedom to choose his or her Medicaid providers. 6405.2 The HIV/AIDS Administration shall provide, as necessary, to all waiver recipients a list of the following at the time of initial enro…

6406 ENROLLMENT CEILING AND WAITING LIST 6406.1 The District's Medical Assistance Administration shall establish a ceiling on the number of participants for each year of the project. If the number of applications exceeds the annual enrollment ceiling prior to the Demonstration Pr…

6407 PROGRAM SERVICES 6407.1 Each applicant determined to be eligible pursuant to the criteria set forth in Section 6401 shall be entitled to full Medicaid benefits, including but not limited to the following services: (a) Laboratory and diagnostic services; (b) Pharmacy benefits…

6408 PROVIDER QUALIFICATIONS 6408.1 Each provider shall enter into a provider agreement with the DOH, Medical Assistance Administration, which shall specify the services to be provided, methods of operation, and financial and legal requirements. 6408.2 Each provider shall furnish…

6409 CONFIDENTIALITY AND DISCLOSURE OF INFORMATION 6409.1 The District and all providers shall protect the confidentiality of all information that identifies individual Demonstration Project recipients. The District and all providers shall maintain the same standards of confident…

6410 TREATMENT OF RECORDS 6410.1 Each provider shall maintain accurate records reflecting treatment, evaluation, and management services. The record for each recipient shall include, but is not limited to, the following information: (a) General information including the patient's…

6411 PATIENT RIGHTS AND RESPONSIBILITIES 6411.1 Each provider participating in the Demonstration Project shall develop a written statement of patient rights and responsibilities consistent with the requirements of this section, which shall be given to each recipient in advance of…

6412 GRIEVANCE AND APPEALS 6412.1 Each Demonstration Project recipient that is aggrieved by a decision of the District affecting that recipient's eligibility to receive a covered service through the Demonstration Project shall be entitled to file a written grievance with the Depa…

6499 DEFINITIONS For the purposes of this Chapter, the following terms shall have the meaning ascribed: AIDS - acquired immune deficiency syndrome. COBRA- Consolidated Omnibus Budget Reconciliation Act of 1986. This program administered by the United States Department of Labor an…

6500 GENERAL PROVISIONS 6500.1 The purpose of this chapter is to establish principles of reimbursement for nursing facilities participating in the District of Columbia Medicaid program. 6500.2 Medicaid reimbursement to nursing facilities for services provided beginning February 1…

6501 REIMBURSEMENT OF DISTRICT NURSING FACILITIES 6501.1 Each nursing facility located in the District of Columbia shall be reimbursed by Medicaid for a patient specific per diem rate for each resident in accordance with the formula set forth in § 6501.2. The rate shall be prospe…

6502 COMPUTATION OF PRICE AND FLOOR 6502.1 DHCF shall classify each nursing facility operating in the District and participating in the Medicaid program into three (3) peer groups: (a) Peer Group One - All freestanding nursing facilities, with more than seventy-five (75) Medicaid…

6503 RESIDENT ASSESSMENT 6503.1 Each nursing facility shall complete an assessment of each resident's functional, medical and psycho-social capacity consistent with the requirements set forth in 42 CFR § 483.20. 6503.2 The Minimum Data Set (MDS), Version 3.0 or successor updates …

6504 RESIDENT CLASSIFICATION SYSTEM 6504.1 DHCF shall use the forty-eight (48)-group resident classification system developed by CMS known as the Resource Utilization Groups IV (RUGS IV), Version 1.03 or successor updates. 6504.2 DHCF shall use the Case Mix Indices known as the s…

6505 FACILITY NURSING AND RESIDENT CARE COSTS PER DIEM CALCULATION 6505.1 Each nursing facility's allowable nursing and resident care Medicaid reimbursable costs shall be adjusted in accordance with § 6505.4. 6505.2 The total resident days shall be determined in accordance with §…

6506 FACILITY ROUTINE AND SUPPORT COSTS PER DIEM CALCULATION 6506.1 In the base year, each facility’s routine and support cost per diem shall be established by dividing total allowable routine and support base year costs adjusted in accordance with § 6501.7 by total resident days…

6507 FACILITY CAPITAL-RELATED COSTS PER DIEM CALCULATION 6507.1 Each nursing facility's capital-related cost per diem shall be calculated by dividing total allowable capital-related base year costs adjusted in accordance with § 6501.7 by total resident days determined in accordan…

6508 VENTILATOR CARE 6508.1 In addition to the patient specific per diem rate described in § 6501.2, DHCF shall pay an additional per diem amount for any day that a resident qualifies for and receives ventilator care pursuant to the requirements set forth in §§ 6508 through 6510.…

6509 VENTILATOR CARE DISCHARGE 6509.1 Each provider shall ensure that residents are weaned from the ventilator when weaning is determined to be medically appropriate. 6509.2 A provider shall discontinue weaning and resume mechanical ventilation if the resident experiences any of …

6510 VENTILATOR CARE REIMBURSEMENT 6510.1 The add-on reimbursement rate for ventilator care shall be three hundred eighty dollars ($380.00) per day for each resident. A public notice of any changes in the ventilator care reimbursement rate shall be published in the D.C. Register …

6511 BEHAVIORALLY COMPLEX CARE 6511.1 In addition to the patient specific per diem rate described in § 6501.2, DHCF shall pay an additional per diem amount for any day that a resident qualifies as behaviorally complex pursuant to the definition set forth in § 6511.2. 6511.2 A beh…

6512 BEHAVIORALLY COMPLEX CARE REIMBURSEMENT 6512.1 The add-on reimbursement rate for behaviorally complex care shall be eighty-two dollars ($82.00) per day for each resident. A public notice of any changes in the behaviorally complex care reimbursement rate shall be published in…

6513 BARIATRIC CARE 6513.1 In addition to the patient specific per diem rate described in § 6501.2, DHCF shall pay an additional per diem amount for any day that a resident qualifies as a bariatric resident pursuant to the requirements set forth in § 6513.2. 6513.2 A bariatric re…

6514 BARIATRIC CARE REIMBURSEMENT 6514.1 The add-on reimbursement rate for bariatric care shall be thirty-nine dollars ($39.00) per day for each resident. A public notice of any changes in the bariatric care reimbursement rate shall be published in the D.C. Register at least thir…

6515 ALLOWABLE COSTS 6515.1 Allowable costs shall include items of expense the provider incurs in the provision of routine services related to resident care including: (a) Room and board, including dietary and nutrition services, food, laundry and linen, housekeeping, routine per…

6516 EXCLUSIONS FROM ALLOWABLE COSTS 6516.1 The following categories of expense shall be excluded from allowable operating costs because they are not normally incurred in providing resident care: (a) Fundraising expenses in excess of ten percent (10%) of the amount raised; (b) Pa…

6517 REBASING AND ANNUAL RATE ADJUSTMENTS 6517.1 Not later than October l, 2021, and every four (4) years thereafter, the base year data, medians, day-weighted medians and peer group prices shall be updated. 6517.2 DHCF retains authority to update the routine and support and the …

6518 REIMBURSEMENT FOR NEW PROVIDERS 6518.1 Each new provider shall be assigned to the appropriate peer group as set forth in § 6502.1. 6518.2 The per diem rate for each new provider shall be the base year day-weighted average case mix neutral peer group price for nursing and res…

6519 REIMBURSEMENT FOR REORGANIZED FACILITIES, EXPANDED FACILITIES, REDUCED CAPACITY, OR CHANGE OF OWNERSHIP 6519.1 A nursing facility that has been reorganized pursuant to Chapter 11 of Title 11 of the United States Bankruptcy Code on or after September 30, 2000 shall be reimbur…

6520 REIMBURSEMENT FOR OUT OF STATE FACILITIES 6520.1 If a District Medicaid beneficiary is placed in an out-of-state facility in accordance with the requirements of § 6520.5, DHCF shall reimburse the facility in accordance with the Medicaid reimbursement rate of the state in whi…

6521 COST REPORTING AND RECORD MAINTENANCE 6521.1 Each nursing facility shall submit an annual cost report to the Medicaid program within one hundred twenty days (120) days of the close of the facility's cost reporting period, which shall be concurrent with its fiscal year used f…

6522 ACCESS TO RECORDS 6522.1 In accordance with the Health Insurance Portability and Accountability Act of 1996 and other privacy laws, each nursing facility shall allow appropriate DHCF personnel, representatives of the federal Department of Health and Human Services and other …

6523 APPEALS 6523.1 At the conclusion of each base year audit or any other required audit, a nursing facility shall receive an audited cost report including a description of each audit adjustment and the reason for each adjustment. 6523.2 Within thirty (30) days of the date of re…

6524 NURSING FACILITY QUALITY IMPROVEMENT PROGRAM 6524.1 Beginning February 1, 2018, DHCF will implement the Nursing Facility Quality Improvement (NFQIP) Program. 6524.2 Participation in the Nursing Facility Quality Improvement Reporting Track is mandatory for all nursing facilit…

6525 PARTICIPATION IN THE NURSING FACILITY QUALITY IMPROVEMENT PROGRAM 6525.1 To participate in the NFQIR track, the nursing facility must: (a) Be located in the District of Columbia; (b) Be enrolled in and seek reimbursement from the District's Medicaid Program as a nursing faci…

6526 NFQII PERFORMANCE SCORING 6526.1 Nursing facilities electing to participate in the NFQII will be assessed for the performance payment based on the facility: Submitting a written statement attesting to compliance or completion of a performance measure accompanied by supportin…

6527 NURSING FACILITY QUALITY OF CARE FUND AND NFQII PERFORMANCE PAYMENT 6527.1 DHCF shall calculate and distribute performance payments based on available funds from the Nursing Facility Quality of Care Fund. 6527.2 DHCF shall calculate the amount of funds available for distribu…

6599 DEFINITIONS 6599.1 When used in this chapter, the following terms shall have the meanings ascribed: Accrual Method of Accounting - a method of accounting pursuant to which revenue is recorded in the period earned, regardless of when collected and expenses are recorded in the…