D.C. Mun. Regs. tit. 22, r. 22-A2504

Current through Register Vol. 71, No. 50, December 13, 2024

Rule 22-A2504 - HEALTH HOME SERVICES ELIGIBILITY

2504.1

To be eligible for Health Home services, a consumer shall:

(a) Be eligible for Medicaid;

(b) Be diagnosed as having a serious and persistent mental illness;

(c) Be enrolled in a CSA or FSMHC; and

(d) Consent to be enrolled in a Health Home and authorize the disclosure of his or her mental health, physical health and other relevant information for the purpose of integrating primary and behavioral health care and services.

2504.2

Consumers may only be enrolled with one (1) Health Home at a time and may opt-out at any time. Providers shall document in writing and in forms prescribed by the Department a consumer's informed consent to opt-in or opt-out of the Health Home program.

2504.3

The following categories of beneficiaries shall not be eligible for the Health Home program under this chapter:

(a) Consumers currently enrolled in Assertive Community Treatment (ACT) as described in Chapter 34;

(b) Consumers enrolled in the Home and Community-Based Services (HCBS) Waiver for the Elderly and Individuals with Physical Disabilities, as described in Chapter 42 of Title 29 of the District of Columbia Municipal Regulations (DCMR);

(c) Consumers enrolled in the HCBS Waiver for Persons with Intellectual and Developmental Disabilities, as described in Chapter 19 of Title 29 DCMR;

(d) Consumers residing in a nursing facility;

(e) Consumers residing in an Intermediate Care Facility for Individuals with Intellectual Disabilities; and

(f) Consumers enrolled in the My Health GPS program, as described in Chapter 102 of Title 29 DCMR. A consumer who is eligible for both this Health Home and the My Health GPS Program may choose to enroll in either program but not both.

D.C. Mun. Regs. tit. 22, r. 22-A2504

Final Rulemaking published at 63 DCR 849 (1/22/2016); amended by Final Rulemaking published at 66 DCR 5625 (5/3/2019)