D.C. Mun. Regs. tit. 29, r. 4200

Current through Register Vol. 71, No. 44, November 1, 2024

Rule 4200 - GENERAL PROVISIONS: IDENTIFICATION OF SERVICES; PROGRAM RESPONSIBILITIES; AND SERVICE SETTING REQUIREMENTS

4200.1

The following Home and Community-Based (HCB) Waiver services are included in this chapter, consistent with the regulations set forth herein:

(a) Case management services;

(b) Personal Care Aide (PCA) services;

(c) Personal Emergency Response System (PERS) services;

(d) Respite services;

(e) Homemaker services;

(f) Chore aide services;

(g) Assisted living services;

(h) Environmental Accessibility Adaptation (EAA) services;

(i) Adult Day Health services;

(j) Physical Therapy services;

(k) Occupational Therapy services;

(l) Individual- Directed Goods and Services;

(m) Participant-Directed Community Supports services; and

(n) Community transition services.

4200.2

DHCF or its designee shall be the first point of contact for applicants who choose to receive EPD Waiver Services. DHCF or its designee shall assist an applicant with the completion of all documents and processes needed to apply for the EPD Waiver including, but not limited to, assisting the applicant with obtaining a face-to-face assessment and obtaining a determination of financial eligibility from DHCF's designee.

4200.3

DHCF or its designee shall conduct face-to-face assessments to determine if the applicant meets the level of care requirements in accordance with Section 4201 of this chapter.

4200.4

DHCF or its designee shall perform the following operational functions:

(a) Review the Person-Centered Service Plan (PCSP) and prior-authorize the services recommended in the PCSP; and

(b) Review requests for change in services and determine if they should be approved; and

(c) Prior-authorize approved changes in services.

4200.5

The EPD Waiver services described in this chapter shall be administered by the Department of Health Care Finance (DHCF), Long-Term Care Administration.

4200.6

All Adult Day Health, Assisted Living, and Community Residence Facility settings shall meet the HCB Setting Requirements pursuant to 42 CFR § 441.301(c)(4) which require that settings :

(a) Be chosen by the beneficiary receiving EPD Waiver services;

(b) Ensure the beneficiary's right to privacy, dignity, and respect, and freedom from coercion and restraint;

(c) Be physically accessible to the beneficiary and allow him or her access to all common areas;

(d) Support the beneficiary's community integration and inclusion, including relationship-building and maintenance, support for self-determination and self-advocacy;

(e) Provide opportunities for the beneficiary to seek employment and meaningful non-work activities in the community;

(f) Provide information on beneficiary rights;

(g) Optimize the beneficiary's initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and choices for personal interaction;

(h) Facilitate the beneficiary's choices regarding services and supports, and the provision of services;

(i) Create personalized daily schedules for each beneficiary receiving supports that includes activities that align with the beneficiary's goals, interest, and preferences, and are reflected in his or her PCSP;

(j) Provide opportunities for the beneficiary to engage in community life;

(k) Provide opportunities to receive services in the community to the same degree as individuals not receiving Medicaid HCBS;

(l) Control over the beneficiary's personal funds and bank accounts; and

(m) Allow visitors at any time except as indicated in the beneficiary's PCSP, based on his or her assessed needs.

4200.7

In addition to the requirements referenced under Subsection 4200.6, all Assisted Living and Community Residence Facility settings shall:

(a) Be integrated in the community;

(b) Provide opportunities for the beneficiary to engage in community life;

(c) Allow full access to the greater community, such as opportunities to seek employment, and access to public libraries with appropriate oversight and assistance to the same extent as access is available to persons who do not receive Medicaid HCBS;

(d) Be leased in the names of the people who are being supported. If this is not possible, then the Assisted Living or Community Residence Facility provider must ensure that each beneficiary has a legally enforceable residency agreement or other written agreement that, at a minimum, provides the same responsibilities and protections from eviction that tenants have under the District's landlord and tenant law. This applies equally to leased and provider owned properties; and

(e) Develop and adhere to policies which ensure that each beneficiary receiving services has the right to the following:

(1) Privacy in the beneficiary's personal space, including entrances that are lockable by the beneficiary (with staff having keys as needed);

(2) Freedom to furnish and decorate his or her personal space (except for a beneficiary receiving Respite Daily services);

(3) Control over his or her personal funds and bank accounts;

(4) Privacy for telephone calls, texts and emails; and

(5) Access to food at any time.

4200.8

Any deviations from the requirements in Subsection 4200.7(e) must be supported by a specific assessed need, which is justified in the beneficiary's written PCSP, and reviewed and approved as a restriction by the case manager in the PCSP.

D.C. Mun. Regs. tit. 29, r. 4200

Final Rulemaking published at 64 DCR 6787 (7/21/2017)