District of Columbia Administrative Code

915 NURSE-MIDWIVES: STANDARDS FOR PARTICIPATION AS INDIVIDUAL PRACTITIONERS IN THE D.C. MEDICAID PROGRAM 915.1 The provisions of this section shall govern the reimbursement of nurse-midwives by the D.C. Medicaid Program for nurse-midwifery services provided as medically necessary…

916 WHO MAY PROVIDE CARE 916.1 The nurse-midwifery services shall meet the following requirements: (a) Be provided by a person who is licensed as a registered nurse in the District of Columbia; (b) Meet the requirements of D.C. Law 6-99; and (c) Execute a provider agreement with …

917 WHERE CARE MAY BE PROVIDED 917.1 Nurse-midwifery services shall be provided as follows: (a) In a hospital on an inpatient or outpatient basis; (b) In a free-standing treatment and diagnostic clinic or free-standing maternity center; (c) In the office of the nurse-midwife or t…

918 COLLABORATION AND PROTOCOL REQUIREMENTS 918.1 Each nurse-midwife shall maintain at all times a current, written protocol for a twenty-four (24) hour collaboration and referral pursuant to the requirements of D.C. Law 6-99. 918.2 Each nurse-midwife shall maintain and submit to…

919 DIRECT MEDICAID REIMBURSEMENT 919.1 The D.C. Medicaid Program shall make direct reimbursement to a nurse-midwife who meets the requirements of §916.1 of this chapter. 919.2 The D.C. Medicaid Program shall make payment for medically necessary services which are furnished by a …

920 [REPEALED] SOURCE: Final Rulemaking published at 50 DCR 6170 (August 1, 2003); as amended by Final Rulemaking published at 53 DCR 2401 (March 31, 2006); as amended by Final Rulemaking published at 54 DCR 2343 (March 16, 2007); as amended by Final Rulemaking published at 55 DC…

921 LEAD INVESTIGATIONS FOR MEDICAID-ELIGIBLE CHILDREN UNDER THE AGE OF TWENTY-ONE 921.1 Medicaid reimbursement shall be available to the D.C. Department of the Environment (“DDOE”) or its agent(s) to conduct investigations that determine the source of lead contamination in the p…

926 [REPEALED] SOURCE: Final Rulemaking published at 39 DCR 7434 (October 2, 1992); as amended by Final Rulemaking published at 50 DCR 6989 (August 22, 2003); as amended by Final Rulemaking published at 55 DCR 2269 (March 7, 2008); as amended by Final Rulemaking published at 64 D…

927 CHANGE OF BASE YEAR FOR HOSPITAL FOR SICK CHILDREN 927.1 For services rendered on or after July 1, 2012, the Hospital for Sick Children’s Medicaid payment for inpatient hospital services is based upon the hospital’s audited allowable cost per diem for the base year period def…

928 ELECTRONIC PAYMENTS INITIATIVE 928.1 This rule shall govern the requirements for enrollment of D.C. Medicaid providers and suppliers into the Electronic Funds Transfer /Automated Clearing House (EFT/ACH) program, a federally regulated network for the processing of electronic …

929 [REPEALED] SOURCE: Final Rulemaking published at 51 DCR 4095 (April 23, 2004); as amended by Final Rulemaking published at 55 DCR 10143 (October 3, 2008); as amended by Final Rulemaking published at 61 DCR 3553 (April 4, 2014). District of Columbia Municipal Regulations Publi…

931 DEFINITIONS 931.1 For purposes of this chapter, the following terms shall have the meanings ascribed: Individual Habilitation Plan (IHP) - The same meaning as set forth in section 403 of the Mentally Retarded Citizens Constitutional Rights and Dignity Act of 1978, effective M…

932 SPEECH, HEARING, AND LANGUAGE SERVICES 932.1 Speech, hearing and language services shall be reimbursed by the Medicaid Program for each participant with mental retardation and developmental disabilities in the Home and Community-based Services Waiver for Persons with Mental R…

933 BENEFICIARY REIMBURSEMENT FOR MEDICAID COVERED SERVICES 933.1 Reimbursement to a Medicaid beneficiary, their authorized representative, or their family member may occur if: (a) A Medicaid covered expense was incurred and paid by or on behalf of the beneficiary, on a date of s…

934 [REPEALED] SOURCE: Final Rulemaking published at 50 DCR 1186 (February 7, 2003); as amended by Final Rulemaking published at 53 DCR 97 (January 6, 2006); as amended by Final Rulemaking published at 55 DCR 7287 (July 4, 2008); as amended by Final Rulemaking published at 61 DCR…

935 [REPEALED] SOURCE: Final Rulemaking published at 37 DCR 3944 (June 15, 1990); as amended by Final Rulemaking published at 50 DCR 1190 (February 7, 2003); as amended by Final Rulemaking published at 53 DCR 102 (January 6, 2006); as amended by Final Rulemaking published at 55 D…

936 [REPEALED] SOURCE: Final Rulemaking published at 37 DCR 3944, 3945 (June 15, 1990); as amended by Final Rulemaking published at 50 DCR 8184 (October 3, 2003); as amended by Final Rulemaking published at 53 DCR 1699 (March 10, 2006); as amended by Final Rulemaking published at…

937 ORGAN TRANSPLANT SERVICES 937.1 The purpose of this section is to establish standards governing Medicaid reimbursement of transplantation services, identify types of transplantation services offered under the Medicaid program, authorize Medicaid coverage for two new transplan…

938 INCREASED REIMBURSEMENT FOR ELIGIBLE PRIMARY CARE SERVICES Except as provided in Subsection 938.2, primary care services eligible for enhanced reimbursement under the Healthcare Common Procedure Coding System (HCPCS) shall include evaluation and management (E&M) services bill…

939 ADULT HOSPICE SERVICES 939.1 This rule shall govern the administration of adult hospice services under the District of Columbia (District) Medicaid Program. 939.2 Adult Hospice services shall be furnished by providers operating in accordance with 42 CFR § 418.114 and requirem…

940 PEDIATRIC PALLIATIVE CARE AND HOSPICE CARE 940.1 These rules establish the standards and conditions of participation for pediatric palliative care and hospice (PPCH) providers providing pediatric hospice services under the District of Columbia Medicaid Program. 940.2 Pediatri…

941 MEDICAID BIRTH CENTER SERVICES AND REIMBURSEMENT 941.1 These rules establish standards governing Medicaid reimbursement for the delivery of services provided to Medicaid beneficiaries at freestanding birth centers located in the District of Columbia. 941.2 A freestanding birt…

942 ATTACHMENT AND BIOBEHAVIORAL CATCHUP 942.1 This rule shall govern the administration of Attachment and Biobehavioral Catchup (ABC) services under the District of Columbia Medicaid Program. 942.2 ABC is an evidence-based home-visiting program that targets key issues among pare…

943 MEDICAID CLINIC SERVICES AND REIMBURSEMENT 943.1 Clinic services for Medicaid beneficiaries shall be furnished in a public or private medically-based facility, under the direction of a physician, nurse midwife or nurse practitioner. 943.2 Clinic services provided by a nurse m…

944 [REPEALED]. SOURCE: Final Rulemaking published at 50 DCR 8188 (October 3, 2003); as amended by Final Rulemaking published at 55 DCR 2858 (March 21, 2008). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 944 AUTHORITY: DC-DCMR An Act to enable the District …

945 [REPEALED] SOURCE: Final Rulemaking published at 50 DCR 6179 (August 1, 2003); as amended by Final Rulemaking published at 54 DCR 2356 (March 16, 2007); as amended by Final Rulemaking published at 55 DCR 2874 (March 21, 2008); as amended by Final Rulemaking published at 55 DC…

946 [REPEALED] SOURCE: Final Rulemaking published at 51 DCR 9699 (October 15, 2004); as amended by Final Rulemaking published at 54 DCR 4394 (May 11, 2007); as amended by Final Rulemaking published at 55 DCR 6856 (June 20, 2008); as amended by Final Rulemaking published at 61 DCR…

947 PRIVATE DUTY NURSING SERVICES 947.1 This section shall establish general standards for conditions of participation for Medicaid providers of Private Duty Nursing services, and delineate specific standards governing reimbursement for these services. 947.2 Private Duty Nursing …

948 INPATIENT PSYCHIATRIC SERVICES FOR INDIVIDUALS UNDER 22 YEARS OF AGE 948.1 Inpatient psychiatric services for individuals under the age of twenty-two (22) may be provided by: (a) A psychiatric hospital or an inpatient psychiatric program in a hospital accredited by the Joint …

949 REIMBURSEMENT PRINCIPLES AND LIMITATIONS GOVERNING PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES 949.1 Each PRTF shall be reimbursed on a prospective basis at a facility-specific per diem rate. 949.2 Each PRTF located in the District of Columbia shall be reimbursed at a rate e…

950 PAYMENT FOR RESERVED BEDS 950.1 Vendor payment for reserved bed days for hospitalization or therapeutic leaves of absence, for a resident of a nursing facility, when provided in the resident's plan of care, shall not exceed eighteen (18) days during any fiscal year, if there …

951 MONTHLY REPORTING REQUIREMENTS FOR RESERVED BED DAYS 951.1 Each provider shall submit to MAA on a monthly basis a status report reflecting the total number of reserved bed days used for each resident during the month and the cumulative total for the fiscal year, including the…

952 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

953 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

954 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

955 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

956 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

957 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

958 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

959 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

960 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

961 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

962 RESERVED SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program and for other purpo…

963 [RESERVED] SOURCE: Final Rulemaking published at 53 DCR 1370 (February 24, 2006). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 963 AUTHORITY: DC-DCMR An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of th…

964 DENTAL SERVICES 964.1 Subject to requirements established in this section, the Department of Health Care Finance (DHCF) shall reimburse for dental services, as further described in these rules, provided to the following eligible populations: (a) Medicaid beneficiaries under t…