D.C. Mun. Regs. tit. 29, r. 4238

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

Rule 4238 - PROGRAM SERVICES: ASSISTED LIVING SERVICES

4238.1

In order to receive Medicaid reimbursement, assisted living services shall be personal care and supportive services that are furnished to beneficiaries who reside in a homelike, non- institutional setting that includes twenty- four (24) hour on-site response capability to meet any scheduled or unpredictable needs of the beneficiary and to provide supervision, safety, and security.

4238.2

Assisted living services shall consist of any combination of the following services that meet the beneficiary's needs as outlined in the written PCSP:

(a) Twenty- four (24) hour supervision and oversight to ensure the well-being and safety of beneficiaries;

(b) Assistance with activities of daily living and instrumental activities of daily living, such as PCA services to meet the scheduled and unscheduled service needs of the beneficiaries;

(c) Laundry and housekeeping tasks that a beneficiary is unable to perform and is normally provided under the Chore Aide and Homemaker services benefit;

(d) Coordinating social and recreational activities;

(e) Coordinating activities to enable access to health and social services, including social work, nursing, rehabilitative, hospice, medical, dental, dietary, counseling and psychiatric services; and

(f) Coordinating scheduled transportation to community-based activities.

4238.3

Consistent with Subsection 4238.2(e), the assisted living provider shall coordinate the delivery of all services provided by third parties. A third party may include home care agencies, hospitals, or clinics or Adult Day Health providers.

4238.4

In situations where a beneficiary is prior authorized for PCA services to supplement services provided by the assisted living provider, the assisted living provider shall facilitate coordination by providing a copy of the individualized service plan (Plan of Care) to the case manager and the home care agency providing PCA services.

D.C. Mun. Regs. tit. 29, r. 4238

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