District of Columbia Administrative Code

9015 ASSISTIVE TECHNOLOGY SERVICES 9015.1 The purpose of this section is to establish standards governing eligibility for assistive technology services for persons enrolled in the Home and Community-Based Services Waiver for Individual and Family Support (IFS Waiver), and to esta…

9016 BEHAVIORAL SUPPORT SERVICES 9016.1 The purpose of this section is to establish standards governing Medicaid eligibility for behavioral support services for persons enrolled in the Home and Community-Based Services Waiver for Individual and Family Support (IFS Waiver), and to…

9017 COMPANION SERVICES 9017.1 The purpose of this section is to establish standards governing the eligibility for Medicaid reimbursement of companion services for people enrolled in the Home and Community-Based Services Waiver for Individual and Family Support (IFS Waiver) and t…

9018 CREATIVE ARTS THERAPIES SERVICES 9018.1 The purpose of this section is to establish standards governing Medicaid eligibility for Creative Arts Therapies services for persons enrolled in the IFS Waiver, and to establish conditions of participation for providers of these servi…

9019 DAY HABILITATION SERVICES 9019.1 The purpose of this section is to establish standards governing Medicaid eligibility for day habilitation for persons enrolled in the IFS Waiver, and to establish conditions of participation for providers of day habilitation services. 9019.2 …

9020 PERSONAL EMERGENCY RESPONSE SYSTEM (PERS) 9020.1 This section establishes the conditions of participation for Medicaid providers enumerated in §§ 9027.7 and 9027.8 (“Medicaid Providers”) to provide Personal Emergency Response System (PERS) services for persons enrolled in th…

9021 EDUCATION SUPPORTS SERVICES 9021.1 The purpose of this section is to establish standards governing Medicaid eligibility for education supports services for persons enrolled in the IFS Waiver, and to establish conditions of participation for providers of education supports se…

9022 EMPLOYMENT READINESS SERVICES 9022.1 This section establishes standards governing Medicaid eligibility for employment readiness services for persons enrolled in the IFS Waiver and establishes conditions of participation for providers of employment readiness services. 9022.2 …

9023 FAMILY TRAINING SERVICES 9023.1 This section shall establish conditions of participation for Medicaid providers enumerated in § 9023.9 (“Medicaid Providers”) and family training services professionals and peer employees enumerated in § 9023.8 to provide family training servi…

9024 INDIVIDUALIZED DAY SUPPORTS SERVICES 9024.1 This section establishes standards governing Medicaid eligibility for individualized day supports services for persons enrolled in the IFS Waiver, and shall establish conditions of participation for providers of individualized day …

9025 IN-HOME SUPPORTS SERVICES 9025.1 The purpose of this section is to establish standards governing Medicaid eligibility for in-home supports services for persons enrolled in the Home and Community-Based Services Waiver for Individual and Family Support (IFS Waiver), and to est…

9026 OCCUPATIONAL THERAPY SERVICES 9026.1 This section shall establish conditions of participation for Medicaid providers enumerated in § 9026.9 (Medicaid Providers) and occupational therapy professionals enumerated in § 9026.8 (professionals) to provide occupational therapy serv…

9027 PARENTING SUPPORT SERVICES 9027.1 The purpose of this section is to establish standards governing eligibility for parenting support services for persons enrolled in the IFS Waiver, and to establish conditions of participation for professionals and providers of parenting supp…

9028 PERSONAL CARE SERVICES 9028.1 The purpose of this section is to establish standards governing Medicaid eligibility for personal care services for individuals enrolled in the IFS Waiver and to establish conditions of participation for providers of personal care services. 9028…

9029 PHYSICAL THERAPY SERVICES 9029.1 This section establishes the conditions for Medicaid providers enumerated in § 9029.10 (“Medicaid Providers”) and physical therapy services professionals enumerated in § 9029.8 (“professionals”) to provide physical therapy services to persons…

9030 RESPITE SERVICES 9030.1 The purpose of this chapter is to establish standards governing Medicaid eligibility for respite services for persons enrolled in the IFS Waiver and to establish conditions of participation for respite providers. 9030.2 Respite services provide relief…

9031 SKILLED NURSING SERVICES 9031.1 The purpose of this section is to establish standards governing Medicaid eligibility for skilled nursing services under the IFS Waiver and to establish conditions of participation for providers of skilled nursing services. 9031.2 Skilled nursi…

9032 SPEECH, HEARING, AND LANGUAGE SERVICES 9032.1 The purpose of this section is to establish standards governing Medicaid eligibility for speech, hearing, and language services for persons enrolled in the IFS Waiver and to establish conditions of participation for providers of …

9033 SUPPORTED EMPLOYMENT SERVICES - INDIVIDUAL AND SMALL GROUP SERVICES 9033.1 This section shall establish standards governing Medicaid eligibility for supported employment services for persons enrolled in the IFS Waiver and shall establish conditions of participation for provi…

9034 WELLNESS SERVICES 9034.1 The purpose of this section is to establish standards governing Medicaid eligibility for wellness services for persons enrolled in the IFS Waiver, and to establish conditions of participation for providers of wellness services in order to receive rei…

9035 INDIVIDUAL-DIRECTED GOODS AND SERVICES 9035.1 In order to receive Medicaid reimbursement, individual-directed goods and services shall only be provided to IFS Waiver beneficiaries who are enrolled as participants in the My Life, My Way program and when purchased from the par…

9036 REMOTE SUPPORTS SERVICES 9036.1 Remote supports services are the provision of supports by staff of a certified provider at a remote location or through an electronic method of service delivery who are engaged with individual(s) through equipment with the capability for live …

9037 ARPA SUPPLEMENTAL PAYMENT FOR SUPPORTED EMPLOYMENT PROVIDERS 9037.1 In accordance with Section 9817 of the American Rescue Plan Act of 2021, approved March 11, 2022 (Pub. L. 117-2; 135 Stat. 4), supplemental payments shall be made to supported employment provider agencies th…

9099 DEFINITIONS 9099.1 When used in this chapter, the following terms and phrases shall have the meanings ascribed: Abbreviated Readiness Process - A process that assures that existing providers that have been approved as HCBS Waiver providers possess and demonstrate the capabil…

9100 GENERAL PROVISIONS 9100.1 The purpose of this chapter is to establish requirements governing Medicaid reimbursement for Adult Substance Use Rehabilitative Services (ASURS). 9100.2 In order to be eligible for treatment in the ASURS program, beneficiaries shall be subject to t…

9101 PROGRAM SERVICES 9101.1 Adult Substance Use Rehabilitative Services (ASURS) shall include the following services: Screening, Assessment and Diagnosis pursuant to requirements at 29 DCMR § 5202; Clinical Care Coordination pursuant to requirements at 29 DCMR § 5216; Crisis Int…

9102 CRISIS INTERVENTION 9102.1 Crisis Intervention is an immediate short-term treatment intervention, which assists an individual to resolve an acute personal crisis that jeopardizes the individual’s treatment, recovery progress, health or safety. 9102.2 Crisis Intervention shal…

9103 MOTIVATIONAL ENHANCEMENT THERAPY-COGNITIVE BEHAVIORAL THERAPY 9103.1 Motivational Enhancement Therapy–Cognitive Behavioral Therapy (MET-CBT) is a short-term intervention designed for children/youth to increase their motivation to change a substance use behavior and the under…

9104 RECOVERY SUPPORT SERVICES 9104.1 Recovery Support Services (RSS) are strength-based supports to assist individuals in achieving or sustaining recovery from a SUD. 9104.2 Recovery Support Services shall: Be provided and billed in fifteen (15) minute units; Be provided in indi…

9105 METHADONE SERVICES IN OPIOID TREATMENT PROGRAMS 9105.1 Methadone is a medication used in Medication Assisted Treatment (MAT) of opioid use disorder (OUD). 9105.2 Methadone services in opioid treatment programs shall: Be delivered in conjunction with counseling/therapy for su…

HYPERLINK "http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=DC-MR&DocName=LK%2829DCADCS809%29&FindType=l" 9106 MEDICALLY MONITORED INPATIENT WITHDRAWAL MANAGEMENT 9106.1 Medically Monitored Inpatient Withdrawal Management (MMIWM) is a twenty-four (24) hour, medically di…

HYPERLINK "http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=DC-MR&DocName=LK%2829DCADCS809%29&FindType=l" 9111 [RESERVED] SOURCE: Final Rulemaking published at 72 DCR 013719 (December 5, 2025). District of Columbia Municipal Regulations Public Welfare 29 DCMR § 9111 AUT…

HYPERLINK "http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=DC-MR&DocName=LK%2829DCADCS809%29&FindType=l" 9112 ELIGIBILITY REQUIREMENTS 9112.1 Only persons who are Medicaid recipients and meet the requirements set forth in Chapter 63 of Title 22-A DCMR shall be eligible…

HYPERLINK "http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=DC-MR&DocName=LK%2829DCADCS809%29&FindType=l" 9113 TREATMENT RECORDS AND ACCESS TO RECORDS 9113.1 In addition to the requirements set forth in Chapter 63 of Title 22-A DCMR, each ASURS treatment record shall co…

HYPERLINK "http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=DC-MR&DocName=LK%2829DCADCS809%29&FindType=l" 9114 REIMBURSEMENT 9114.1 Reimbursement for ASURS shall be made according to the District of Columbia Medicaid fee schedule available online at www.dc-medicaid.com.…

HYPERLINK "http://www.westlaw.com/Find/Default.wl?rs=dfa1.0&vr=2.0&DB=DC-MR&DocName=LK%2829DCADCS809%29&FindType=l" 9115 AUDITS AND REVIEWS 9115.1 This section sets forth the requirements for audits and reviews of ASURS services. DHCF shall perform regular audits of ASURS provide…

9200 GENERAL PROVISIONS 9200.1 The purpose of this chapter is to establish limitations for reimbursement by the Medicaid program for provider preventable conditions. These rules shall: (a) Identify Provider Preventable Conditions (PPCs) which shall be included in the Department o…

9201 HEALTH CARE ACQUIRED CONDITIONS 9201.1 HCACs subject to payment adjustments under the District of Columbia’s Medicaid program shall include those preventable medical conditions that were not present upon admission to an inpatient hospital setting, but were acquired after an …

9202 OTHER PROVIDER PREVENTABLE CONDITIONS 9202.1 Other Provider Preventable Conditions (OPPCs) shall include erroneous medical procedures as identified by Medicare under three (3) national coverage determinations (NCDs) that deny coverage when a practitioner performs the wrong p…

9203 CLAIMS RECOUPMENT OR RECONCILIATION 9203.1 For those beneficiaries dually-eligible for Medicare and Medicaid, the District’s Medicaid PPC payment adjustment policy shall also apply to those claims denied under Medicare’s preventable conditions policy. 9203.2 A Medicaid provi…

9299 DEFINITIONS 9299.1 For purposes of this chapter, the following terms shall have the meanings ascribed: Base year – The standardized year on which rates for all hospitals for outpatient hospital services are calculated to derive a prospective payment system. Beneficiary – An …

9300 GENERAL PROVISIONS In accordance with the requirements set forth in § 1902(a)(42)(B)(i) of the Social Security Act (the Act), (42 USC § 1396a(a)(42)(B)(i)), and 42 CFR §§ 455.500 et seq., the Department of Health Care Finance (DHCF) shall establish the Medicaid Recovery Audi…

9301 MEDICAL RECORDS REQUESTS 9301.1 Each provider shall make medical records available to the Medicaid RAC upon request, subject to the provisions in this section. Providers may submit medical records in hardcopy or electronic format. Providers shall have thirty (30) business da…

9302 GUIDELINES FOR RECOUPING OVERPAYMENTS AND RECONCILING UNDERPAYMENTS A Medicaid provider may be subject to recoupment or reconciliation of claims based on the Medicaid RAC findings. A determination of overpayment or underpayment shall be based on, but not limited to, one or m…

9399 DEFINITIONS For the purposes of this chapter, the following terms shall have the meanings ascribed: Audit – A systematic process where an entity reviews Medicaid claims, obtains evidence, evaluates findings, and determines compliance with applicable laws, regulations, and po…