D.C. Mun. Regs. tit. 29, r. 29-11104
In order to receive Medicaid reimbursement for individualized day supports services, the participant's Individual Support Plan (ISP) and Plan of Care, must document that the need for the service is consistent with the participant's assessed needs and personally chosen goals including what is important to and for the participant as documented in his or her Person-Centered Thinking and Discovery Tools and recorded in the ISP and Plan of Care, and show at least one of the following:
Medicaid reimbursable individualized day supports services shall:
Medicaid reimbursable individualized day supports services shall provide:
Medicaid shall only reimburse individualized day supports services for a minimum of two (2) and a maximum of six (6) hours per day; and a minimum of four (4) and a maximum of thirty (30) hours per week. This service may be offered in combination with Day Habilitation, Employment Readiness, Supported Employment services as a wraparound service in combination with any of the aforementioned services. When two or more of these services are offered, a participant may not receive more than a combined total of forty (40) hours per week of services.
Individualized day supports are an alternative to facility-based day programs and shall take place during regular Monday to Friday day program hours; except that individualized day supports may occur during non-traditional hours for participants who are employed during the day and would benefit from the service. Additional variances may be approved by the DDS Director, or his or her designee, based upon the participant's assessed needs, schedule of other activities, and recommendations of the participant's support team.
Time spent in transportation to and from IDS generally shall not be included in the total amount of services provided per day. However, IDS may include the time a PDW spends accompanying the participant on public transportation (excluding Medicaid-funded non-emergency transportation) for the purposes of training the participant to travel using public transportation, including when the participant's IDS day begins and ends at the participant's residence. IDS and Medicaid-funded non-emergency transportation may not be billed during the same period of time. Medicaid-funded non-emergency transportation may not be used during the provision of IDS. Medicaid-funded non-emergency transportation may be used to transport the participant to and from IDS; however, it should not preclude opportunities for the participant to learn to use public transportation as part of participation in IDS.
Personal care/assistance may be a component of individualized day supports as necessary to meet the needs of a participant but may not comprise the entirety of the service.
This service shall not provide reimbursement to Senior Centers funded by the federal Older Americans Act of 1965, as amended (42 U.S.C. § 3044(b)) authorized to provide services to older adults.
The Individualized Day Program does not include activities that are the responsibility of the in-home supports provider, such as cooking or laundry activities.
A participant receiving individualized day supports may meet their PDW at a facility-based day habilitation or employment readiness setting, but only if this is necessary and appropriate for the participant receiving the services. Individualized day services shall not occur in a facility-based setting. On site attendance at the facility-based day habilitation or employment readiness program is not a requirement to receive services that originate from that setting.
A participant receiving IDS may start and end his or her day at his or her place of residence, if that is the participant's preference and/or is recommended by the participant's support team and reflected in their ISP and Plan of Care.
Participants receiving individualized day supports services may receive two (2) or more types of non-residential habilitation services, (e.g., Supported Employment, Small Group Supported Employment, Employment Readiness, Companion, and/or Day Habilitation); however, more than one (1) service may not be billed during the same period of time (e.g., the same fifteen (15) minute unit).
IDS in the My Life, My Way program shall be designed to promote independence and safeguard the health, welfare, and safety of the participant.
In order to be reimbursed by Medicaid, IDS shall be provided at a one-to-one ratio through the My Life, My Way program.
The participant or their authorized representative, as applicable, shall serve as a "common law employer" of the PDW providing services. In the role of "common law employer," the participant or authorized representative shall be responsible for recruiting, hiring, supervising and discharging PDWs providing IDS.
Supports shall be available to assist the participant/representative-employer with their own employer-related responsibilities as described in § 11104.15 through the VF/EA FMS-Support Broker entity.
All PDS provided by a PDW shall be prior authorized by DDS or its agent in order to be reimbursed under the My Life, My Way program.
To be eligible for PDS IDS, a participant shall be in receipt of a service authorization for IDS from DDS or its designated agent that specifies the amount, duration, and scope of services authorized to be provided to the participant, in accordance with Subsection 9024 of Chapter 90 of Title 29 DCMR.
The hourly wage paid to a PDW shall be no lower than the living wage in the District, set in accordance with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01et seq.), and no higher, including employment taxes and insurance amounts, than the current rate paid for agency-based IDS.
Payment for IDS shall be provided in accordance with the participant's PDS budget, at an hourly wage set by the participant/representative-employer which falls within the wage range established by DHCF as set forth in § 11104.19.
D.C. Mun. Regs. tit. 29, r. 29-11104