D.C. Mun. Regs. tit. 29, r. 4210
Case management services shall be reimbursable on a per member per month (PMPM) basis.
The PMPM reimbursement rate during Waiver Year 5 and Waiver Year 1 of the Renewal shall be two hundred forty- five dollars and ninety-six cents ($245.96), contingent on performance of the monthly and ongoing care coordination activities outlined in Section 4224.
In order for a case management agency to receive reimbursement for case management services, each Case Manager must perform case management duties either on a full-time or on a part-time basis. At any point in time, no more than forty- five (45) beneficiaries shall be assigned to each Case Manager.
The case management agency shall ensure case management services are available during regular business hours and shall be on call during weekends and evenings in case of emergency.
Reimbursement for transitional case management services provided during a hospital or nursing facility (i.e., institutional) stay shall not exceed one hundred twenty (120) days. Reimbursement shall be contingent on the Case Manager's performance of activities during the institutional stay that facilitate transition to the community, consistent with the reimbursement standards for transitional case management set forth in Subsection 4224.9.
Reimbursement for transitional case management services shall be made only after the beneficiary returns to the home or community setting and not during the beneficiary's institutional stay.
D.C. Mun. Regs. tit. 29, r. 4210