District of Columbia Administrative Code

9715 ALTERNATIVE SANCTIONS FOR ADHPs 9715.1 DHCF may impose alternative sanctions against an ADHP when that provider fails to meet the programmatic requirements or any requirements set forth in this Chapter, but the violation does not place an ADHP participant’s health or safety …

9716 DENIAL OF PAYMENT RELATING TO NEW ADMISSIONS 9716.1 In lieu of termination in situations where participants are not in immediate jeopardy, DHCF may initiate a one-time denial of payment for claims associated with new admissions at the ADHP site that fail to comply with one (…

9717 DIRECTED PLAN OF CORRECTION (DPoC) 9717.1 In lieu of termination in situations where the ADHP is not in compliance with the programmatic requirements, and ADHP participants are not in immediate jeopardy, DHCF may require an ADHP to take prompt, or immediate action specified …

9718 DIRECTED IN-SERVICE TRAINING (DIST) 9718.1 In lieu of termination in situations where the ADHP is not in compliance with programmatic requirements, but participants are not in immediate jeopardy, DHCF may require an ADHP to implement Directed In-Service Training (DIST) for d…

9719 PROGRAM COMPLIANCE MONITORING 9719.1 Program compliance monitoring shall be the District of Columbia’s oversight of efforts made by the ADHP to correct cited deficiencies. State monitoring shall be a safeguard against the ADHP provider’s further noncompliance. 9719.2 The fol…

9720 DISCHARGE AND REFERRAL 9720.1 A participant shall be discharged from the ADHP program under one (1) of the following conditions: (a) If the participant is found upon reassessment that his/her acuity is below the level of need described under Section 9709; (b) If the particip…

9721 SERVICE LIMITATIONS 9721.1 A person shall not receive ADHP services if they reside in an institutional setting or any setting that is not in compliance with the HCBS setting requirements consistent with 42 CFR § 441.301 and 42 CFR § 441.710. 9721.2 A provider shall not be re…

9722 COST REPORTING 9722.1 Each ADHP site shall report direct services, treatment, and plant and capital costs on an annual basis to DHCF no later than ninety (90) business days after the end of the provider’s cost reporting period, which shall correspond to the fiscal year used …

9723 REIMBURSEMENT POLICY 9723.1 Reimbursement rates shall be based on a uniform per diem rate that is differentiated based on the participant’s acuity level as established by the standardized need- based assessment tool and process described under Section 9709, as follows: (a) A…

9724 ARPA SUPPLEMENTAL PAYMENT FOR ADULT DAY HEALTH PROGRAM PROVIDERS 9724.1 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 adult day health programs (ADHP) that…

9799 DEFINITIONS When used in this section, the following terms and phrases shall have the meanings ascribed: Acuity level - A participant’s level of health and support needs determined by the assessment tool. ADHP plan of care - A written plan developed by the provider to implem…

9800 GENERAL PROVISIONS 9800.1 This chapter establishes standards governing financial eligibility determinations and post-eligibility treatment of income for long term care services and supports (LTCSS), which include health-related care and services provided in a nursing facilit…

9801 INCOME TEST 9801.1 In order to be eligible for LTCSS, an applicant or beneficiary shall have gross countable income at or below the Special Income Standard (SIS), which is equal to three hundred percent (300%) of the SSI federal benefit rate (FBR), except as identified at Su…

9802 RESOURCE TEST 9802.1 In order to be eligible for LTCSS, an applicant or beneficiary shall not have gross countable resources that exceed four thousand dollars ($4,000). 9802.2 Individuals identified at Subsection 9800.2(a) shall be exempt from the resource test in Subsection…

9803 IMPROPER RESOURCE TRANSFERS AND PENALTY PERIOD 9803.1 At the time of the initial eligibility determination, the Department shall conduct a review to determine whether the applicant, the applicant’s spouse, or an individual with legal authority to act in place of or on behalf…

9804 POST-ELIGIBILITY TREATMENT OF INCOME 9804.1 The Department shall determine how much monthly income a beneficiary must contribute toward the cost of LTCSS after an initial eligibility determination. 9804.2 The Department shall project the beneficiary’s gross countable monthly…

9899 DEFINITIONS For the purposes of this chapter, the following terms shall have the meanings ascribed: Community Maintenance Needs Allowance (CMNA): A standard income amount that an HCBS Waiver participant living at home may retain to afford the costs associated with living in …

9900 GENERAL PROVISIONS 9900.1 This chapter establishes general standards for conditions of participation for Medicaid providers and delineates specific standards governing Medicaid reimbursement for the following Home Health services: (a) Skilled Nursing services as described in…

9901 SKILLED NURSING SERVICES 9901.1 Medicaid reimbursable Skilled Nursing services are part-time or intermittent skilled nursing care services that are needed by a beneficiary due to an illness or injury, and are furnished by nurses in accordance with the beneficiary’s plan of c…

9902 HOME HEALTH AIDE SERVICES 9902.1 Medicaid reimbursable Home Health Aide services are services that are required by a beneficiary due to an illness or injury, and include assistance with activities of daily living, assistance with self-administered medications, or other clini…

9903 PHYSICAL THERAPY SERVICES 9903.1 Medicaid reimbursable Physical Therapy services are skilled services designed to treat a beneficiary’s identified physical dysfunction or reduce the degree of pain associated with movement, injury or long term disability. Physical Therapy ser…

9904 OCCUPATIONAL THERAPY SERVICES 9904.1 Medicaid reimbursable Occupational Therapy services are skilled services designed to maximize independence, gain skills, prevent further disability, and develop, restore, or maintain a beneficiary’s daily living and work skills. 9904.2 Me…

9905 SPEECH PATHOLOGY AND AUDIOLOGY SERVICES 9905.1 Medicaid reimbursable Speech Pathology and Audiology services are skilled therapeutic interventions to address communicative and speech disorders to maximize a beneficiary’s expressive and receptive communication skills and are …

9906 AUDITS AND RECORD MAINTENANCE 9906.1 All Medicaid reimbursable Skilled Nursing, Home Health Aide, Physical Therapy, Occupational Therapy, Speech Pathology and Audiology services shall adhere to the audit and record maintenance requirements set forth in this section. 9906.2 R…

9907 ARPA SUPPLEMENTAL PAYMENT FOR HOME HEALTH AIDES 9907.1 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 home health agencies providing home health aide servic…

9999 DEFINITIONS 9999.1 When used in this chapter, the following terms shall have the following meanings: Adaptive Equipment - Medical devices used to assist the beneficiary in performing activities of daily living. Medically Necessary - A physician’s determination that a benefic…

100 ESTABLISHMENT AND AUTHORITY OF THE BOARD 100.1 The District of Columbia Lottery and Charitable Games Control Board ("Board") was established by the "Law to Legalize Lotteries, Daily Numbers Games and Bingo and Raffles for Charitable Purposes in the District of Columbia," D.C.…

101 OFFICERS OF THE BOARD 101.1 The officers of the Board shall be a Chairperson, Vice Chairperson and Treasurer. 101.2 A Board member shall hold only one (1) of the offices set forth in § 101.1 at any one time. 101.3 The position of Chairperson of the Board shall be filled in ac…

102 DUTIES OF OFFICERS OF THE BOARD 102.1 The Chairperson's duties shall be as follows: (a) Act as official spokesperson for the Board; Provided, that the Chairperson shall represent the position of the Board as established by a majority of the Board; (b) Preside at all meetings …

103 COMMITTEES OF THE BOARD 103.1 The Board shall be composed of one (1) standing committee, which shall be the Committee of the Whole. 103.2 The Committee of the Whole shall review all matters presented by the Executive Director and make recommendations to the Board on those mat…

104 REGULAR MEETINGS 104.1 Regular meetings of the Board shall be held monthly. 104.2 The regular meetings shall be held at 6:30 p.m. on the first Wednesday of each month; Provided, that a meeting may be changed by the Chairperson, with the concurrence of the majority of the Boar…

105 COMMITTEE OF THE WHOLE MEETINGS 105.1 The Committee of the Whole shall be composed of all members of the Board. 105.2 Committee of the Whole Meetings shall be held monthly. 105.3 The Committee of the Whole meeting shall be held two (2) weeks before the regular Board meeting a…

106 AD HOC COMMITTEE MEETING 106.1 The Chairperson of any ad hoc committee or any two (2) members of an ad hoc committee may call a meeting of the committee by informing the Executive Director of the purpose of the meeting not less than forty-eight (48) hours before the meeting. …

107 SPECIAL MEETINGS 107.1 Special meetings of the Board may be called to conduct official business of the Board between regular Board meetings. 107.2 The Chairperson of the Board may call a special meeting of the Board by informing the other Board members of the purpose of the s…

108 EMERGENCY MEETINGS 108.1 The Chairperson .of the Board may call an emergency meeting of the Board by informing the other Board members of the nature of the emergency and the purpose of the meeting. 108.2 Any three (3) members of the Board may call an emergency meeting of the …

109 CONDUCT OF MEETINGS 109.1 All meetings of the Board shall be held at the Office of the Board unless specifically changed by majority vote of the Board. Notwithstanding any other provisions of this subsection, all meetings shall be held within the District. 109.2 Board meeting…

110 EXECUTIVE SESSIONS 110.1 For the purpose of this chapter, the term "executive session" means a Board meeting or subcommittee meeting where the public, employees of the Board, or any other person may be excluded. 110.2 In accordance with Pub.L. 93-198 title VII, §742, D.C. Off…

111 COMMUNITY MEETINGS 111.1 The Board may call a community meeting at any time to hear from members of the public on any matter of concern to the Board or public. 111.2 Members of the public shall be placed on the agenda of a community meeting by informing the Executive Director…

112 RECORDKEEPING 112.1 The records of the Board shall be maintained at the Board's Office. 112.2 Transcripts of Board proceedings as required by law or this chapter shall be maintained at the Board's office. SOURCE: Final Rulemaking published at 33 DCR 3704, 3712 (June 20, 1986)…

113 PUBLICATION AND PUBLIC DOCUMENTS 113.1 Minutes of the Board shall be published upon approval by a majority of the Board. 113.2 The public, upon request, may obtain copies of the following: (a) Transcripts, or portions of transcripts, of regular monthly meetings, special meeti…

114 EXECUTIVE DIRECTOR 114.1 In accordance with D.C. Code §2-2503 (1994 Repl. Vol.), the Executive Director shall be appointed and may be removed by a majority vote of the Board. 114.2 In accordance with D.C. Code §2-2503 (1994 Repl. Vol.), the Executive Director, subject to Boar…

1000 SWEEPSTAKES, BONUS AND PROMOTIONAL GAMES 1000.1 The Agency may conduct sweepstakes, contests, bonus games, second chance drawings, or other promotional games and campaigns. 1000.2 For the purposes of Chapters 5 through 10, the term "sweepstakes" shall include all promotional…

1100 SCOPE OF CHAPTER 1100.1 This chapter establishes procedures for implementing iLottery game rules, iLottery registration and participation requirements, iLottery Account requirements and iLottery responsible gaming requirements. SOURCE: Final Rulemaking published at 68 DCR 26…

1101 LOTTERY PRODUCTS AVAILABLE THROUGH iLOTTERY 1101.1 The Executive Director shall authorize and determine the availability of lottery products through iLottery and for purchase of lottery products using an iLottery Account. SOURCE: Final Rulemaking published at 68 DCR 2691 (Ma…

1102 TRADITIONAL LOTTERY PRODUCTS 1102.1 The Executive Director may authorize the sale of traditional lottery products through iLottery and for purchase using an iLottery Account. 1102.2 Traditional lottery products delivered through an iLottery Account may be delivered to a regi…

1103 CATEGORIES OF iLOTTERY GAMES 1103.1 In addition to traditional lottery products, the Executive Director may authorize the following types of iLottery games: (a) Numbers games; (b) Instant Win games; (c) KENO and other monitor-style games; and (d) Cash-out games. 1103.2 The o…

1104 iLOTTERY GAME DESCRIPTION 1104.1 The Executive Director shall post an iLottery game description on the Office’s website and the Office’s mobile application for each iLottery game, with the following minimum information: (a) The name of the iLottery game; (b) The purchase pri…

1105 USE OF THE OFFICE’S iLOTTERY MOBILE APPLICATION OR WEBSITE 1105.1 To deposit funds or purchase a play of an iLottery game or product using Office’s Mobile Application or Website a player must: (a) Be at least eighteen (18) years of age; (b) Have a valid iLottery Account; (c)…

1106 iLOTTERY ACCOUNTS 1106.1 To apply for an iLottery Account, a player must provide all information requested on the registration form including, the player’s full legal name, address, date of birth, and the player’s Social Security Number. 1106.2 By submitting an application f…

1107 iLOTTERY ACCOUNT FUNDING 1107.1 A player may deposit funds into their iLottery Account by using a credit card, debit card, ACH bank transfer, or any other method approved by the Office. 1107.2 By initiating a deposit, the player represents and warrants that they: (a) Have au…