D.C. Mun. Regs. tit. 22, r. 22-A6501

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-A6501 - ELIGIBILITY FOR TRANSITION PLANNING SERVICE

6501.1

To be eligible for the Medicaid- funded transition planning service, individuals shall meet the following requirements:

(a) Be:

(1) A child or youth with mental health problems, as defined in D.C. Official Code § 7-1131.02(1F);

(2) An adult with mental illness as defined in D.C. Official Code § 7-1131.02(24); or

(3) An individual with a substance use disorder (SUD), as defined in Subsection 6301.1 of Chapter 63 of this subtitle;

(b) Be a bona fide resident of the District, as defined in D.C. Official Code § 7-1131.02(29);

(c) Be enrolled in Medicaid or be eligible for enrollment and in the process of applying;

(d) Be experiencing an institutional treatment stay described in §6501.2; and

(e) Not be enrolled in any one of the following District programs:

(1) Medicaid managed care;

(2) Home and Community-Based Services Waiver for Persons who are Elderly and Individuals with Physical Disabilities, as described in Title 29 DCMR Chapter 42;

(3) Home and Community- Based Services Waiver for Individuals with Intellectual and Developmental Disabilities, as described in Title 29 DCMR Chapter 19;

(4) DC Health Home, as described in Title 22-A DCMR Chapter 25; or

(5) My Health GPS, as described in Title 29 DCMR Chapter 102.

6501.2

An individual meeting the criteria described in§6501.1 shall be eligible for the transition planning service if they are experiencing an institutional stay in an inpatient hospital or residential SUD treatment setting related to a primary mental health or SUD diagnosis, and the service is rendered to the individual within thirty (30) calendar days ahead of and/oron the day of discharge from the:

(a) Inpatient hospital setting into an outpatient or community-based setting, or SUD residential treatment setting; or

(b) SUD residential treatment setting into an outpatient or community-based setting, or a lower level SUD residential treatment setting.

D.C. Mun. Regs. tit. 22, r. 22-A6501

Final Rulemaking published at 68 DCR 876 (1/15/2021)