D.C. Mun. Regs. tit. 29, r. 29-1940
The Department on Disability Services (DDS), through its Developmental Disabilities Administration (DDA), may establish a waiting list for people who are otherwise eligible for and requesting services and supports through enrollment in the District of Columbia Medicaid program's Home and Community-Based Services Waiver for Persons with Intellectual and Developmental Disabilities (HCBS IDD waiver), consistent with the approved HCBS IDD waiver, No. DC.0307.R03.00, as approved November 20, 2012, and in accordance with the requirements of the Department on Disability Services Establishment Act (D.C. Law 16-264; D.C. Official Code §§ 7-761.05(7) (2012 Repl.)), and as further amended.
A person is considered "eligible" if he or she meets the requirements for DDA services as set forth in D.C. Official Code §§ 7-761.02(3A) and 7-1301.03(8D), and as amended by the Developmental Disability Eligibility Reform Amendment Act of 2022, effective May 18, 2022 ( D.C. Law 24-117; D.C. Official Code §§ 7761.02 et seq.) and the eligibility criteria for participation in the HCBS IDD waiver program, which are found in the approved HCBS IDD waiver application, and are linked to the ICF/IID level of care criteria and are set forth in 29 DCMR §§ 1902.1 to 1902.4. Waiver eligibility criteria require that a person be:
All eligible people requesting supports, services, and HCBS IDD waiver enrollment shall be treated in a manner that is consistent with the terms of the HCBS IDD waiver, in accordance with the order of priority specified below.
An eligible person seeking HCBS supports and services may do so through application to the HCBS IDD waiver program. The HCBS IDD waiver program is approved by the federal Centers for Medicare and Medicaid Services (CMS) to serve up to a set number of participants each year based on the approved HCBS IDD waiver application, as may be amended. If HCBS IDD waiver openings are not available because the maximum number of participants is being served, taking into account reserved capacity, DDA will establish a waiting list for deferred HCBS IDD waiver enrollment.
Consistent with CMS requirements and based on the availability of appropriated funds for these services, DDA will make every reasonable effort to ensure that eligible people on the waiting list will be enrolled and begin to receive HCBS IDD waiver supports and services as quickly as feasible given the availability of waiver slots and the order of priority established by the terms of the waiver and these rules and the availability of funds.
The application of each eligible person who applies for HCBS IDD waiver supports and services will be reviewed by DDA using the DDA Level of Need Assessment and Screening Tool (LON), or its successor.
Based on the HCBS IDD waiver requirements and subject to the availability of appropriated funds for these services, eligible people on the waiting list for supports and services funded through the HCBS IDD waiver will be removed from the waiting list and be enrolled and begin to receive HCBS waiver supports and services in the following priority order, based upon the results of the Level of Need, or its successor, assessment:
Priority Need: The following eligible people would be considered to have a "priority need" for enrollment in the HCBS IDD waiver:
Emergency Need: A person is considered to have an "emergency need" for enrollment in the HCBS IDD waiver if the health and safety of the person or others is in imminent danger and the situation cannot be resolved absent the provision of such services available from the HCBS IDD waiver program. Criteria for determining an emergency need include, but are not limited to:
Urgent Need: A person is considered to have an "urgent need" for enrollment in the HCBS IDD waiver if he or she is at significant risk of having his or her basic needs go unmet. Basic needs include the need for shelter, to eat, maintain one's health and to be free from harm, injury or threats to one's person or property.
Non-Urgent Need: A person is considered to have a "non-urgent need" for enrollment in the HCBS IDD waiver if he or she:
For people with the same priority status, when there are openings available in the HCBS IDD waiver DDA shall review all candidates and, based upon their needs as determined by the LON, shall make a determination of order of placement. Length of time on the waiting list shall be a factor considered, but is not solely considered to determine order of placement.
Based on funding availability, DDA will provide immediate non-waiver services to people on the waiting list who have been identified as having a priority or emergency need:
The application of each person on the waiting list will be reviewed by DDA at least quarterly to determine any change in the support needs of the person, the person's family, and other relevant circumstances affecting the support needs of the person. A review of a change in priority status will also be initiated within five (5) business days of the request by the person, or any member of his or her support team.
Once a person's application has been approved for HCBS IDD waiver enrollment, the person will be assigned a service coordinator, who shall assist the person with completing his/her HCBS IDD waiver application and with development of the person's Individual Service Plan and HCBS IDD waiver Plan of Care.
If the person is seeking out of home residential services through enrollment in the HCBS IDD waiver program, the person must be Medicaid-eligible and the person and his or her caregiver must be willing to accept available residential opportunities if necessary that meet the person's primary needs at the time of assessment.
DDA will refer and assist people on the waiting list to identify, apply for and, when appropriate, obtain services from other District of Columbia or community based agencies for which they might be eligible, including services through the Medicaid State Plan.
A person may be removed from the waiting list for HCBS IDD waiver service for any of the following reasons:
Each person on the waiting list and his or her legal representative shall be provided sufficient information and opportunity to request an agency review of any DDA decision with which they disagree relating to the person's placement on the waiting list, priority status or removal from the waiting list for reasons other than enrollment and initiation of HCBS IDD waiver services.
The agency review contemplated by this provision is an informal process by which the person and his or her legal representative may seek reconsideration of a DDA decision by the DDS Deputy Director for DDA, or his or her designee, and requires a written request for reconsideration setting forth the factual and legal basis for the disagreement relating to the person's placement on the waiting list, determination of order of priority status, or removal from the waiting list. Request for agency review must be made within thirty (30) days plus five (5) for mailing) from the date the written notice in §§ 1940.22 and 1940.23 was mailed, unless there is good cause for a late request.
Each person placed on the waiting list or removed from the waiting list for reasons other than enrollment and initiation of HCBS IDD waiver services shall be entitled to a fair hearing at the Office of Administrative Hearings (OAH) in accordance with 42 CFR 43, D.C. Official Code §§ 4-210.01et seq., and 29 DCMR §§ 1909.1 to 1909.3. Each person on the waiting list and their legal representative shall have thirty (30) calendar days from receipt of the written notice in §§ 1940.22 and 1940.23 to demand a fair hearing.
DDA shall provide to each person on the waiting list and their legal representative timely and adequate written notice of the DDA decision to place the person on the waiting list or to remove the person from the waiting list (for reasons other than enrollment and initiation of HCBS IDD waiver services).
In addition to the written notice provided under §§ 1940.21, DDA shall send each person on the waiting list and their legal representative written notice of the DDA's decision to continue the person's placement on the waiting list beyond the first six (6) months, and twice annually thereafter.
DDS shall publish an annual report on the waiting list during the prior fiscal year, which shall include a demographic profile of people on the waiting list; aggregate information on the level of need and requested supports and services of people on the waiting list; information about the length of time people have been on the waiting list; provide projected annual costs to meet the aggregate needs of all people on the waiting list; and discuss methods to reduce the waiting list and maximum waiting period.
DEFINITIONS
When used in this section, the following terms and phrases shall have the meanings ascribed:
Aged Out - Refers to the threshold age when people receiving services from certain agencies are no longer eligible such services, but may then become eligible for services and supports from DDA. These include wards of the state that are residentially funded by the Children and Family Services Agency and, upon turning the age of twenty two (22), if they choose to continue to receive supports and meet the eligibility criteria for DDA, DDA provides those supports.
CMS - The Centers for Medicare and Medicaid Services is the federal agency under Title XIX of the Social Security Act responsible for approving HCBS waiver applications and monitoring the operation of waiver programs in the states and the District of Columbia.
Department on Disability Services (DDS) - The agency that provides services to District of Columbia residents with intellectual and other disabilities through its Developmental Disabilities Administration and Rehabilitation Services Administration.
Evans class member - Refers to any person who was a former resident of Forest Haven and therefore is identified as a member of the class as defined in the Order to Amend Class Action Order in Evans v. Washington, Civil Action No. 76-0293 (D.D.C. filed Jan. 19, 1977).
Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (HCBS IDD waiver) - The HCBS IDD waiver is a District of Columbia Medicaid program as approved by the Council of the District of Columbia and CMS that funds home and community-based services and supports as an alternative to receiving services in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).
HCBS IDD Waiver Waiting List - The list of people who have been reviewed and assessed by DDA, have been assigned a priority ranking, and are waiting for an opening in the DDA HCBS waiver program to be enrolled and receive services.
Intermediate Care Facility for Individuals With Intellectual Disabilities (ICF/IID) - ICFs/IID are Medicaid State Plan funded residential settings that provide all residential (room and board), day/vocational, therapeutic, habilitative, supervision and transportation services as specified in the person's Person Support Plan. ICF/IID homes are certified and licensed by the D.C. Department of Health.
ICF/IID Level of Care Criteria - These criteria establish the diagnostic and functional eligibility criteria for HCBS IDD waiver services and are set forth in 29 DCMR §§ 1902.1 to 1902.4, as amended.
Reserved Capacity - reserve capacity is a number of waiver slots set aside for people who are currently in an ICF/IID setting who want to move to smaller, integrated residential settings through the waiver, as well as a commitment to wards of the State who are transitioning from the Children and Family Services Agency ("CFSA") to adult services in DDS/DDA that are placed in out-of-home services to ensure a seamless transfer to adult services, and for people currently enrolled in the Individual and Family Supports ("IFS") waiver who may need to transition to the IDD waiver due to an increased level of need and/or services exceeding the seventy-five thousand dollar ($75,000) cap in the IFS waiver.
Residential Supports - A broad term used to describe options for people who need housing supports (i.e. rent, food, utilities and supplies) outside of the family or person's home in addition to paid staff supports, clinical services or other HCBS waiver services. Residential supports are included if a person chooses to receive services through the Medicaid State Plan ICF/IID program. Residential supports are not included in the HCBS IDD waiver program (except for Host Home and Live-in Caregiver Services, in part), and therefore must be requested and managed separately from HCBS IDD waiver enrollment. Residential supports for persons participating in the HCBS IDD waiver program are one hundred percent (100%) dependent upon local funding, and should be combined with housing vouchers, food stamps, cash benefits, wages and other sources of housing subsidies to maximize the capacity of DDA to support all people who need such support.
D.C. Mun. Regs. tit. 29, r. 29-1940