District of Columbia Administrative Code

965 OPTOMETRY SERVICES 965.1 Optometry services related to vision and vision disorders that are obtained for the purpose of diagnosis and treatment, including lenses, frames, other aids to vision, and therapeutic drugs, provided consistent with the requirements set forth in 42 C.…

966 SPECIAL INCOME AND RESOURCE ALLOWANCES FOR COMMUNITY SPOUSES OF CERTAIN INSTITUTIONALIZED PERSONS 966.1 If an institutionalized person is determined eligible for medical assistance, and has a spouse living in the community, and income of the institutionalized spouse is made a…

967 CHANGE OF BASE YEAR FOR COLUMBIA HOSPITAL FOR WOMEN, PROVIDENCE HOSPITAL AND WASHINGTON HOSPITAL CENTER 967.1 Columbia Hospital for Women, Providence Hospital and Washington Hospital Center’s Medicaid payment for inpatient services is based upon each hospital’s audited reimbu…

971 CHANGE OF BASE YEAR FOR HOSPITAL FOR SICK CHILDREN 971.1 Beginning one day after the effective date of these rules, 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…

988 MEDICAID FEE SCHEDULE The Medicaid fee schedule includes reimbursement rates for Medicaid covered services and is posted at HYPERLINK "http://www.dc-medicaid.com" www.dc-medicaid.com. Medicaid covered services that are listed on the fee schedule include, but are not limited t…

989 LONG TERM CARE SERVICES AND SUPPORTS ASSESSMENT PROCESS 989.1 The purpose of this section is to establish the Department of Health Care Finance (DHCF) standards governing the District Medicaid assessment process for Long Term Care Services and Supports (LTCSS) and to establis…

990 INDEPENDENTLY LICENSED BEHAVIORAL HEALTH PRACTITIONERS 990.1 The following independently licensed behavioral health practitioners (individual and group) shall be eligible to enroll in the District of Columbia Medicaid Program and provide behavioral health services, regardless…

OTHER LABORATORY AND X-RAY SERVICES 991.1 Medicaid reimbursable other laboratory and x-ray services shall be professional and technical laboratory and radiological services that are: Medically necessary; Ordered, in writing, by a physician or advanced practice registered nurse (A…

992 REIMBURSEMENT TO FEE-FOR-SERVICE PROVIDERS FOR SELECTED FREQUENT PROCEDURES 992.1 The Department shall reimburse a fee-for-service provider for the following frequent procedures or services: Selected Frequent Procedures Procedure Code Price Microbial Identification, Nucleic A…

993 STANDARDS FOR INTERPROFESSIONAL CONSULTATION REIMBURSEMENT 993.1 Interprofessional consultation occurs when a beneficiary’s treating practitioner (physician or other qualified health provider) requests the opinion and/or treatment advice of a consulting practitioner (physicia…

994 STANDARDS FOR COLLABORATIVE CARE SERVICES REIMBURSEMENT 994.1 Collaborative Care is integrated behavioral health and primary care that extends the capabilities of the primary care team to identify and treat people with less complex behavioral conditions, including but not lim…

995 MEDICAID PHYSICIAN AND SPECIALTY SERVICES RATE METHODOLOGY 995.1 Medicaid reimbursement rates for fee-for-service physician and specialist services shall be eighty percent (80%) of the rates paid by the Medicare Program as set forth in this section, except for physician-admin…

996 PROVIDER OF DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES 996.1 A provider/supplier of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) shall be governed by Chapter 94 of Title 29 District of Columbia Municipal Regulations (DCMR), the…

997 DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES 997.1 The Department of Health Care Finance (DHCF), the single state agency for the administration of medical assistance programs authorized under titles XIX and XXI of the Social Security Act, shall ensure the p…

997 MEDICAL ALERT DEVICES AND SERVICES 998.1 Medical alert devices and services include equipment, systems, and services which enable an individual to secure help in the event of an emergency or are used to provide an individual with reminders of medication or treatment schedules…

999 DEFINITIONS 999.1 For purposes of 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 th…

9000 GENERAL PROVISIONS 9000.1 The purpose of this chapter is to establish criteria governing Medicaid eligibility for services under the Home and Community-Based Services (HCBS) Waiver for Individual and Family Support (IFS Waiver) and to establish conditions of participation fo…

9001 COVERED SERVICES AND RATES 9001.1 Services available under the IFS Waiver shall include the following: Assistive Technology Services, 29 DCMR § 9015; Behavioral Support Services, 29 DCMR § 9016; Companion Services, 29 DCMR § 9017; Creative Arts Therapies Services, 29 DCMR § …

9002 ELIGIBILITY REQUIREMENTS 9002.1 To receive IFS Waiver services a person shall be currently receiving services from the Department on Disability Services/Developmental Disabilities Administration (DDS/DDA) and meet all of the following requirements: Have a special income leve…

9003 LEVEL OF CARE AND FREEDOM OF CHOICE 9003.1 The DC Level of Need (LON) is a comprehensive assessment tool, initiated by the Service Coordinator and completed with the person, their advocate and other members of their support team who serve as the resource for providing the in…

9004 INDIVIDUAL SUPPORT PLAN (ISP) 9004.1 The Individual Support Plan (ISP) is the plan that identifies the supports and services to be provided to the person and the evaluation of the person’s progress on an on-going basis to assure that the person’s needs and desired outcomes a…

9005 INDIVIDUAL RIGHTS 9005.1 Each Waiver provider shall develop and adhere to policies which ensure that each person receiving services has the right to the following: Be treated with courtesy, dignity, and respect; Direct the person-centered planning of his or her supports and …

9006 RECORDS AND CONFIDENTIALITY OF INFORMATION 9006.1 Each Waiver provider shall allow appropriate personnel of DHCF, DDS, and other authorized agents of the District of Columbia government or of other jurisdictions where services are provided, and the federal government full ac…

9007 INITIATING, CHANGING, OR TERMINATING ANY APPROVED SERVICES A provider shall hold a support team meeting and provide each person receiving Waiver services and the person's representative at least thirty (30) calendar days advance written notice of intent to initiate, suspend,…

9008 HOME AND COMMUNITY-BASED SETTING REQUIREMENTS 9008.1 All Day Habilitation, Small Group Day Habilitation, Individualized Day Supports, Companion, Supported Employment, Small Group Supported Employment and Employment Readiness settings shall: Be chosen by the person from HCBS …

9009 PROVIDER ENROLLMENT PROCESS 9009.1 Prospective providers shall send a letter of intent to DDA to enroll as a Medicaid provider of Waiver services to the Letter of Intent mailbox at HYPERLINK "mailto:letterofintent.potentialproviders@dc.gov" \h letterofintent.potentialprovide…

9010 PROVIDER QUALIFICATIONS 9010.1 Home and Community-Based Services (HCBS) Waiver provider agencies shall complete an application to participate in the Medicaid Waiver program and shall submit to DDS both the Medicaid provider enrollment application and the following organizati…

9011 REQUIREMENTS FOR DIRECT SUPPORT PROFESSIONALS 9011.1 The basic requirements for all employees and volunteers providing direct services, with the exception of peer support employees as set forth in § 9011.3, are as follows: Be at least eighteen (18) years of age; Obtain annua…

9012 COST REPORTS, AUDITS, AND OVERSIGHT MONITORING 9012.1 Each Waiver provider of day habilitation, in-home supports, individualized day supports, respite, employment readiness, and supported employment services shall report costs to DHCF no later than ninety (90) days after the…

9013 REPORTING REQUIREMENTS 9013.1 Each Waiver provider shall submit quarterly reports to the DDS Service Coordinator no later than seven (7) business days after the end of the first quarter, and each subsequent quarter thereafter. 9013.2 For purposes of reporting, the first quar…

9014 WAITING LIST 9014.1 The DDS, through DDA, may establish a waiting list for individuals who are otherwise eligible for and requesting services and supports through enrollment in the IFS waiver, consistent with the approved IFS waiver, and in accordance with the requirements o…