District of Columbia Administrative Code

6600 PURPOSE 6600.1 The Interim Disability Assistance (IDA) Program shall provide temporary financial assistance to disabled adults who are ineligible for Temporary Assistance for Needy Families (TANF) and who have applied for and are waiting approval of Supplemental Security Inc…

6601 ELIGIBILITY REQUIREMENTS 6601.1 An individual shall be eligible for IDA if he or she is: (a) A United States citizen; or (b) An alien who meets the alien eligibility requirements for SSI under Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of…

6602 APPLICATION PROCESS 6602.1 A qualified individual's eligibility for IDA benefits shall begin on the first of the month following the month that he or she applied for IDA or the month following the month in which his or her application for SSI was filed with the SSA, whicheve…

6603 DENIAL OF APPLICATION 6603.1 The application for IDA shall be denied if: (a) The applicant refuses to cooperate with the Income Maintenance Administration (IMA) in providing the information needed to determine eligibility; (b) The conditions of non-financial eligibility have…

6604 DURATION OF BENEFITS 6604.1 A qualified individual's eligibility for IDA benefits shall end either at the end of the month in which SSA makes a final decision on the application for SSI benefits, if the SSA's decision is a denial of the application; or at the end of the mont…

6605 PAYMENTS 6605.1 IDA benefits shall be issued through electronic benefit transfer (EBT) accounts. 6605.2 Rental vendor payments shall not be deducted from IDA benefits. SOURCE: Final Rulemaking published at 50 DCR 4948(June 20, 2003).

6606 DISABILITY REQUIREMENTS 6606.1 If an applicant for IDA has previously been determined by SAA not to satisfy the disability requirements for SSI, the Department shall evaluate disability in the same manner as under the Medicaid Program, as provided in 42 C.F.R. 435.541. 6606.…

6607 REPAYMENT OF BENEFITS 6607.1 For any month or period of months in which an IDA recipient receives both IDA and SSI, he or she shall repay to the District of Columbia: (a) The entire amount of the IDA payments received if the SSI benefits received for the same period equaled …

6608 RECERTIFICATION FOR BENEFITS; REINSTATEMENT 6608.1 An IDA recipient shall recertify for benefits within twelve (12) months of the month of the individual's approval and every twelve (12) months thereafter. 6608.2 The following eligibility requirements shall be redetermined a…

6609 HEARING RIGHTS 6609.1 Any applicant or recipient who is dissatisfied with an action taken by the Department, which affects his or her IDA benefits, participation or requirements, shall have the right to request a fair hearing. 6609.2 The hearing process shall be conducted in…

6699 DEFINITIONS 6699.1 The following terms and phrases shall have the meanings ascribed: "Applicant" - a person who is applying for Interim Disability Assistance and applying for benefits. He or she may assert eligibility for himself or herself or as the authorized representativ…

6700 GENERAL PROVISIONS 6700.1 The purpose of this Chapter is to identify those services subject to recovery by the Medicaid program after the death of the Medicaid recipient; define the criteria for estate recoveries and circumstances where the District may waive recovery based …

6701 SERVICES SUBJECT TO RECOVERY 6701.1 The Medicaid Program may impose a lien on both real and personal property of a Medicaid recipient after the recipient's death subject to the limitations set forth in this Chapter. 6701.2 All services and health premiums paid under the Dist…

6702 LIMITATIONS 6702.1 The Department of Health, Medical Assistance Administration (MAA) shall not impose a lien against the decedent's home if any of the following persons is lawfully residing in the home: (a) the decedent's surviving spouse; (b) the decedent's child who is und…

6703 UNDUE HARDSHIP 6703.1 Undue hardship shall exist if one of the following criteria has been met: (a) The heir, legatee, devisee or other interested person may become eligible for assistance payments without the proceeds from the estate; (b) The decedent's home is the sole-inc…

6704 PROCEDURES FOR WAIVING ESTATE RECOVERY 6704.1 The application for Medicaid benefits shall contain language to inform each Medicaid applicant that recoveries against the estate of each Medicaid recipient may be undertaken. 6704.2 MAA shall provide written notice of the propos…

6705 APPEALS 6705.1 Decisions made by MAA and communicated in the formal response described in subsections 6704.5 and 6704.6, may be appealed, within thirty (30) days of the date of MAA's letter notifying the personal representative or attorney of record of the decision, to the O…

6799 DEFINITIONS When used in this Chapter, the following terms and phrases shall have the meanings ascribed: Devisee means a recipient of property, usually real property, by will. Estate shall include all real and personal property and any interest in such property that is owned…

6801 SCOPE 6801.1 The purpose of this chapter is to establish criteria and procedures regarding the provision of a subsidy under the Grandparent Caregivers Pilot Program (Pilot Program). 6801.2 The Pilot Program provides subsidies for grandparents, great-grandparents, great-aunts…

6802 ELIGIBILITY 6802.1 To the extent that funds are specifically appropriated for the Pilot Program, an applicant shall be eligible to receive a subsidy under the Pilot Program if each of the following criteria is met: (a) The applicant has submitted a completed application pack…

6803 APPLICATION PROCESS 6803.1 Each applicant shall submit a completed application packet. 6803.2 The application packet shall include the following: (a) The application form, which shall include a signed statement, sworn under penalty of perjury, that all information provided i…

6804 DOCUMENTATION OF STATUS AS PRIMARY CAREGIVER 6804.1 The applicant shall demonstrate that he or she is the primary caretaker of the child by providing at least one of the following documents: (a) A court order granting custody of the child to the applicant; (b) A court order …

6805 CRIMINAL BACKGROUND CHECK AND CHILD PROTECTION REGISTER CHECK 6805.1 At the choice of the applicant, the criminal background checks required under this chapter may be obtained directly through the Metropolitan Police Department (MPD) or through CFSA. 6805.2 If the criminal b…

6806 SUBSIDY 6806.1 The amount of the subsidy an applicant is eligible to receive shall be within five percent (5%) (no less than 95% and no more than 105%) of the regular daily rate of the subsidy for a long-term permanent Level 1 guardianship subsidy pursuant to Title 29 DCMR C…

6807 SUBSIDY AGREEMENT 6807.1 An applicant shall enter into a subsidy agreement with CFSA prior to receiving a subsidy. 6807.2 The amount of the subsidy stated in the subsidy agreement shall be the sole and complete amount of funds an individual shall receive under the Pilot Prog…

6808 RECERTIFICATION 6808.1 If the applicant seeks recertification of the subsidy, CFSA shall conduct a review of the subsidy to determine whether the recipient remains eligible in accordance with this chapter. 6808.2 The recipient shall establish continued eligibility. 6808.3 Th…

6809 APPEAL PROCEDURE 6809.1 Except as provided in § 6809.2, an applicant or recipient who is aggrieved by a decision of CFSA in connection with eligibility for a subsidy may appeal the decision in accordance 29 DCMR, Chapter 59. 6809.2 An applicant or recipient may not appeal an…

6810 CONFIDENTIALITY 6810.1 CFSA shall maintain the confidentiality of information and records concerning an application for or receipt of a subsidy. Information or records may only be released as permitted by applicable provisions of District or federal law. SOURCE: Final Rulema…

6899 DEFINITIONS 6899.1 The following terms and phrases shall have the meanings ascribed: "Adult" - An individual who is 18 years of age or older. "Applicant" - An individual who is applying for a subsidy provided under the Grandparent Caregivers Pilot Program. "Application" - A …

6900 GENERAL PROVISIONS 6900.1 The purpose of this chapter is to establish standards governing Medicaid reimbursement for Health Home services provided by Core Services Agencies (CSA) and Free Standing Mental Health Clinics (FSMHCs) certified as Health Homes by the Department of …

6901 PROGRAM SERVICES 6901.1 Beneficiaries eligible to receive Health Home services shall be Medicaid beneficiaries who meet the requirements set forth in 22-A DCMR § 2504. 6901.2 Health Home services include the following services, as set forth in 22-A DCMR § 2505, and further d…

6902 REIMBURSEMENT 6902.1 Medicaid reimbursement for Health Home services is on a per member per month (PMPM) reimbursement schedule. The month time period shall begin on the first (1st) of the month and end on the last day of the month. 6902.2 Health Homes are required to provid…

6903 HEALTH HOME RECORD RETENTION, PROTECTION AND ACCESS 6903.1 Health Home records shall contain sufficient information which readily identifies and supports Medicaid billing. As set forth in 22-A DCMR § 2516.3, Health Homes shall document each Health Home service and activity i…

6904 AUDITS AND REVIEWS 6904.1 This section sets forth the requirements for audits and reviews of Health Home services. DHCF shall perform regular audits of Health Home providers to ensure that Medicaid payments are consistent with efficiency, economy and quality of care, and mad…

6999 DEFINITIONS 6999.1 When used in this chapter, the following words shall have the meanings ascribed: Behavioral Health Care – care that promotes the well-being of individuals by intervening and preventing incidents of mental illness, substance abuse, or other health concerns.…

701 STAFFING REQUIREMENTS: GENERAL 701.1 The provider shall employ qualified individuals to furnish the required services. 701.2 There shall be a minimum of two (2) full-time professional staff members, one (1) of whom shall be a social worker. 701.3 Additional personnel shall be…

702 PROGRAM DIRECTOR 702.1 The provider shall appoint one (1) of the full-time professional staff members as the Program Director. 702.2 The Program Director in any day treatment program shall have at least a Bachelor's Degree from an accredited college or university and shall me…

703 ACTIVITIES COORDINATOR 703.1 An Activities Coordinator shall have a minimum of one (1) or more years of experience working in an adult or elderly social or recreational program. 703.2 An Activities Coordinator shall have the ability to develop and implement therapeutic activi…

704 NURSES AND PHYSICIANS 704.1 Except as provided in §704.2, the provider shall employ a registered nurse (RN) who shall be on the site daily for a minimum of four (4) scheduled hours. 704.2 If there are eighteen (18) participants or more, the registered nurse shall be on the si…

705 SOCIAL WORKERS, THERAPISTS, AND OTHER STAFF 705.1 A social worker shall coordinate and provide individual, group, and family counseling. 705.2 In specialized day treatment programs, the social worker shall have had at least one (1) year of experience in working with the speci…

706 PARTICIPATION REQUIREMENTS 706.1 A day treatment program provider desiring to participate as a service provider in the D.C. Medicaid Program shall be certified by the Department of Human Services as fully in compliance with all of the requirements set forth in this chapter. 7…

707 PHYSICAL PLANT REQUIREMENTS 707.1 The day treatment program site shall offer easy accessibility by the specialized population being served to public transportation, and easy accessibility to emergency vehicles. 707.2 The building that houses the program shall meet the require…

710 PROGRAM SERVICES 710.1 The services described in this section and §711 shall be available in all day treatment programs. 710.2 Nursing services shall be provided for the coordination and implementation of the individual care plan. Health counseling and supervision of maintena…

711 NUTRITION SERVICES 711.1 Nutrition services shall be provided in accordance with this section. 711.2 A hot meal or snacks, or both, shall be prepared under the direction of a dietitian and shall be provided in accordance with the schedule below, to every participant each day …

712 ADMISSION PROCEDURES 712.1 Prior to an individual's first day in a day treatment facility, the provider shall obtain the following information in a written statement from a physician: (a) The individual's medical history, which shall indicate a physical examination has taken …

713 DISCHARGE AND REFERRAL 713.1 A participant shall be discharged from the day treatment program under one (1) of the following conditions: (a) If the participant demonstrates improvement sufficient to enable him or her to live more independently; (b) If the participant requires…

714 SPECIAL ADMISSION REQUIREMENTS FOR MENTALLY RETARDED PERSONS 714.1 Prior to the admission of a person who is at least moderately retarded to any day treatment program, the interdisciplinary team for the program shall review the individual's IHP to determine if the program can…