D.C. Mun. Regs. tit. 29, r. 29-1904

Current through Register 71, No. 45, November 7, 2024

Rule 29-1904 - PROVIDER QUALIFICATIONS

1904.1

HCBS Waiver provider agencies shall complete an application to participate in the Medicaid Waiver program and shall submit to DDS both the Medicaid provider enrollment application and the following organizational information:

(a) A resume and three (3) letters of reference demonstrating that the owner(s)/operators(s) have a degree in the Social Services field or a related field with at least three (3) years of experience of working with people with intellectual and developmental disabilities; or a degree in a non-Social Services field with at least five (5) years of experience working with people with intellectual and developmental disabilities, unless waiver by the Department on Disability Services Deputy Director for the Developmental Disabilities Administration;

(b) Documentation proving that the program manager of the HCBS Waiver provider agency has a Bachelor's degree in the Social Services field or a related field with at least five (5) years of experience in a leadership role or equivalent management experience working with people with intellectual and developmental disabilities or a Master's degree in the Social Services field or a related field with at least three (3) years of experience in a leadership role or equivalent management experience working with people with intellectual and developmental disabilities;

(c) A copy of the business license issued by the Department of Consumer and Regulatory Affairs (DCRA);

(d) A description of ownership and a list of major owners or stockholders owning or controlling five percent (5%) or more outstanding shares;

(e) A list of Board members representing a diverse spectrum of the respective community and their affiliations;

(f) A roster of key personnel, with qualifications, resumes, background checks, local license, if applicable, and a copy of their position descriptions;

(g) A copy of the most recent audited financial statements of the agency performed by a third-party Certified Public Accountant or auditing company (not applicable for a new organization);

(h) A copy of the basic organizational documents of the provider, including an organizational chart, and current Articles of Incorporation or partnership agreements, if applicable;

(i) A copy of the Bylaws or similar documents regarding conduct of the agency's internal affairs;

(j) A copy of the certificate of good standing from the DCRA;

(k) Organizational policies and procedures, such as personnel policies and procedures required by DDS and available at: http://dds.dc.gov/DC/DDS/Developmental+Disabilities+Administration/Policies?nav=1;

(l) A continuous quality assurance and improvement plan that includes community integration and person-centered thinking principles and values as intentional outcomes for persons supported;

(m) A copy of professional/business liability insurance of at least one million dollars ($1,000,000) prior to the initiation of services, or more as required by the applicable Human Care Agreements;

(n) A sample of all documentation templates, such as progress notes, evaluations, intake assessments, discharge summaries, and quarterly reports;

(o) For providers of Supported Living, Supported Living with Transportation, Host Homes, and Residential Habilitation, a Continuity of Operations Plan;

(p) For providers, of Supported Living, Supported Living with Transportation, Host Homes, Residential Habilitation, In Home Supports, Day Habilitation, Individualized Day Supports, and Employment Readiness, evidence fiscal and organizational accountability; and

(q) Any other documentation deemed necessary to support the approval as a provider.

1904.2

Professional service provider applicants who are in private practice as an independent clinician and are not employed by an enrolled HCBS Waiver provider agency of residential or day/vocational services or a Home Health Agency, shall complete and submit to DDS the Medicaid provider enrollment application and the following:

(a) Documentation to prove ownership or leasing of a private office, even if services are always furnished in the home of the person receiving services;

(b) A copy of a professional license in accordance with District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq.), as amended, and the applicable state and local licenses in accordance with the licensure laws of the jurisdiction where services are provided; and

(c) A copy of the insurance policy verifying at least one million dollars ($1,000,000) in liability insurance.

1904.3

Home Health Agencies shall complete and submit to DDS the Medicaid provider enrollment application and the following documents:

(a) A copy of the Home Health Agency license pursuant to the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code §§ 44-501et seq.), and implementing rules; and

(b) If skilled nursing is utilized, a copy of the registered nurse or licensed practical nurse license in accordance with District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq.), as amended, and the applicable state and local licenses in accordance with the licensure laws of the jurisdiction where services are provided.

1904.4

In order to provide services under the Waiver and qualify for Medicaid reimbursement, DDS approved HCBS Waiver providers shall meet the following requirements:

(a) Maintain a copy of the approval letter issued by DHCF;

(b) Maintain a current District of Columbia Medicaid Provider Agreement that authorizes the provider to bill for services under the Waiver;

(c) Obtain a National Provider Identification (NPI) number from the National Plan and Provider Enumeration System website;

(d) Comply with all applicable District of Columbia licensure requirements and any other applicable licensure requirements in the jurisdiction where services are delivered;

(e) Maintain a copy of the most recent Individual Support Plan (ISP) and Plan of Care that has been approved by DDS for each person;

(f) Maintain a signed copy of a current Human Care Agreement with DDS for the provision of services, if determined necessary by DDS;

(g) Ensure that all staff are qualified, properly supervised, and trained according to DDS policy;

(h) Ensure that a plan is in place to provide services for non-English speaking people pursuant to DDA's Language Access Policy available at: http://dds.dc.gov/publication/language-access-policy;

(i) Offer the Hepatitis B vaccine to all employees with potential exposure;

(j) Ensure that staff are trained in infection control procedures consistent with the standards established by the Federal Centers for Disease Control and Prevention (CDC) and the U.S. Department of Labor, Occupational Safety and Health Administration (OSHA), as set forth in 29 C.F.R. §§ 1910.1030;

(k) Ensure compliance with the provider agency's policies and procedures and DDS policies such as, reporting of unusual incidents, human rights, language access, employee orientation objectives and competencies, individual support plan, most integrated community based setting, health and wellness standards, behavior management, and protection of the person's funds, available at: http://dds.dc.gov/page/policies-and-procedures-dda;

(l) For providers of Supported Living, Supported Living with Transportation, Host Homes, Residential Habilitation, In-Home Supports, Day Habilitation, Individualized Day Supports, and Employment Readiness, complete mandatory training in Person-Centered Thinking, Supported Decision-Making, Supporting Community Integration, and any other topics as determined by DDS;

(m) Provide a written staffing schedule for each site where services are provided, if applicable;

(n) Maintain a written staffing plan, if applicable;

(o) Develop and implement a continuous quality assurance and improvement system, that includes person-centered thinking, community integration, and compliance with the HCBS Settings Rule, to evaluate the effectiveness of services provided;

(p) Ensure that a certificate of occupancy is obtained, if applicable;

(q) Ensure that a certificate of need is obtained, if applicable;

(r) Obtain approval from DDS for each site where residential, day, employment readiness, and supported employment services are provided prior to purchasing or leasing property;

(s) Ensure that, if services are furnished in a private practice office space, spaces are owned, leased, or rented by the private practice and used for the exclusive purpose of operating the private practice;

(t) Ensure that a sole practitioner shall individually supervise assistants and aides employed directly by the independent practitioner, by the partnership group to which the independent practitioner belongs, or by the same private practice that employs the independent practitioner;

(u) Complete the DDA abbreviated readiness process, if applicable;

(v) Participate, and support willing waiver recipients to participate, in the National Core Indicators surveys, or successors surveys, as requested by DDS and/ or its assigned contractors; and

(w) Adhere to the specific provider qualifications in each service rule.

1904.5

Each service provider under the Waiver for which transportation is included or otherwise provided shall:

(a) Ensure that each vehicle used to transport a person has valid license plates;

(b) Ensure that each vehicle used to transport a person has at least the minimum level of motor vehicle insurance required by law;

(c) Present each vehicle used to transport a person for inspection by a certified inspection station every six (6) months, or as required in the jurisdiction where the vehicle is registered, and provide proof that the vehicle has passed the inspection by submitting a copy of the Certificate of Inspections to DDS upon request, except in circumstances where transportation is not included in the Waiver service;

(d) Ensure that each vehicle used to transport a person is maintained in safe, working order;

(e) Ensure that each vehicle used to transport a person meets the needs of the person;

(f) Ensure that each vehicle used to transport a person has seats fastened to the body of the vehicle;

(g) Ensure that each vehicle used to transport a person has operational seat belts;

(h) Ensure that each vehicle used to transport a person can maintain a temperature conducive to comfort;

(i) Ensure that each vehicle used to transport a person is certified by the Washington Metropolitan Area Transit Commission, except in circumstances where transportation is not included in the Waiver service;

(j) Ensure that each person is properly seated when the vehicle is in operation;

(k) Ensure that each person is transported to and from each appointment in a timely manner;

(l) Ensure that each person is provided with an escort on the vehicle, when needed;

(m) Ensure that each vehicle used to transport a person with mobility needs is adapted to provide safe access and use;

(n) Ensure that each staff/employee/contractor providing services meets the requirements set forth in §§ 1906 of these rules, except that a staff/employee/ contractor who works exclusively as a driver is exempt from §§ 1906.1(h), but must be trained on use of the vehicle safety restraints and any specific safety needs of the person being transported; and

(o) Ensure that each staff/employee/contractor providing services be certified in Cardiopulmonary Resuscitation (CPR) and First Aid.

(p) Encourage the use of community-based transportation, as appropriate and described in the ISP.

1904.6

In order to provide services under the Waiver and qualify for Medicaid reimbursement, a QIDP, also known as a QDDP, shall oversee the initial habilitative assessment of a person; develop, monitor, and review ISPs; and integrate and coordinate Waiver services. The QIDP shall meet at least one (1) of the following qualifications:

(a) A psychologist with at least a master's degree from an accredited program and with specialized training or one (1) year of experience in intellectual disabilities;

(b) A physician licensed to practice medicine in the District and with specialized training in intellectual disabilities or with one (1) year of experience in treating persons with intellectual disabilities;

(c) An educator with a degree in education from an accredited program and with specialized training or one (1) year of experience in working with persons with intellectual disabilities;

(d) A social worker with a master's degree from an accredited school of social work and with specialized training in intellectual disabilities or with one (1) year of experience in working with persons with intellectual disabilities;

(e) A rehabilitation counselor who is certified by the Commission on Rehabilitation Counselor Certification and who has specialized training in intellectual disabilities or one (1) year of experience in working with persons with intellectual disabilities;

(f) A therapeutic recreation specialist who is a graduate of an accredited program and who has specialized training or one (1) year of experience in working with persons with intellectual disabilities;

(g) A human service professional with at least a bachelor's degree in a human services field (including, but not limited to, sociology, special education, rehabilitation counseling, and psychology) and who has specialized training in intellectual disabilities or one (1) year of experience in working with persons with intellectual disabilities; or

(h) A registered nurse with specialized training in intellectual disabilities or with one (1) year of experience in working with persons with intellectual disabilities.

D.C. Mun. Regs. tit. 29, r. 29-1904

Final Rulemaking published at 51 DCR 10207 (November 5, 2004); as amended by Final Rulemaking published at 61 DCR 4406 (May 2, 2014); amended by Final Rulemaking published at 63 DCR 10445 (8/12/2016); amended by Final Rulemaking published at 71 DCR 10372 (8/16/2024)

Authority: An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2012 Repl. & 2013 Supp.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).