D.C. Mun. Regs. tit. 29, r. 29-799

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

Rule 29-799 - DEFINITIONS

799.1

When used in this chapter, the following terms and phrases shall have the meanings ascribed:

Day treatment program (DTP) - a nonresidential program operated for the purpose of providing medically supervised day treatment services for elderly persons, children from birth through age three (3), or adults with a developmental disability, and adults with mental disorders.

Developmental disability - a severe, chronic disability of a person that is attributable to a mental or physical impairment, or both, that is manifested before the person attains the age of twenty-two (22) years and is likely to continue indefinitely. The disability causes substantial functional limitations in three (3) or more of the following areas of major life activity:

(a) Self-care;

(b) Receptive and expressive language;

(c) Learning;

(d) Mobility;

(e) Self-direction;

(f) Capacity for independent living; or

(g) Economic sufficiency;

A developmental disability reflects the person's need for a combination and sequence of special, interdisciplinary or generic care, treatment, or other service which are life-long or of extended duration, and are individually planned and coordinated.

Elderly - a Title XIX (Medicaid) eligible individual, age sixty-five (65) or over, who requires health care supervision for a part of his or her day if he or she is to remain in the community, or if he or she is to move from twenty-four (24) hour institutional care to the community.

Habilitation services - a variety of services designed to maximize the functioning of mentally retarded persons or persons with related conditions. Services provided may include monitoring of health care needs, behavior management, money management, social skills, personal care skills, and practical living skills.

Least restrictive environment - that living or habilitation arrangement which least inhibits an individual's independence and right to liberty that can be effective in meeting the individual's needs.

Maintenance therapy services - supplemental or follow-up therapies performed by day treatment program staff members under the direction of occupational, physical, or speech therapist, the program's registered nurse, or both.

Maladaptive behavior - a condition in which a person manifests socially unacceptable modes of expressions, and which requires the person to receive domiciliary or institutional care, but which is stable enough to allow him or her to participate in a DTP.

Medically supervised - the supervision, by a licensed physician, of treatment services for all program participants.

Mental disorder - an abnormal mental condition in an individual, who requires the comprehensive and relatively intensive full range of mental health services in a therapeutic and structured environment if he or she is to remain in the community or if he or she is to move from twenty-four (24) hour institutional care to the community.

Mental health professional - any of the following:

(a) Psychiatric nurse - a registered nurse who holds a Master's Degree from a school of nursing of recognized standing, and is eligible for certification as a Psychiatric Mental Health Nursing Specialist by the American Nurses Association;

(b) Psychiatrist - a physician who has completed a residency in psychiatry approved by the American Board of Psychiatry and Neurology and who is licensed to practice medicine in the jurisdiction in which the program operates;

(c) Psychologist - the holder of a Doctoral Degree in Psychology conferred by a graduate school of recognized standing, who is licensed in the jurisdiction in which the program operates;

(d) Social worker - the holder of a Master's Degree in Social Work from an accredited university and social work program accredited by the council on Social Work Education, and who meets the qualifications set by the Clinical Registers of the National Association of Social Workers and the Federation of Clinical Social Workers; or

(e) Other mental health professionals - persons in this category are not considered automatically qualified to perform services reimbursable under Title XIX, nor considered eligible to serve as Program Directors, until and unless prior approval is granted in writing by the Administrator, Mental Health Services Administration, Department of Human Services. These persons are those having equivalent professional education, training, and experience in mental health disciplines or behavioral sciences.

Mental retardation - a significant sub-average general intellectual level determined in accordance with standard measurements, existing concurrently with impairment in adaptive behavior, which originates during the developmental period.

New Admission: an individual is a new admission, on or after January 1, 2013, if that individual did not receive day treatment services between October 1, 2012 and December 31, 2012 from any day treatment provider under these rules. An individual who changes from one day treatment provider to another, on or after January 1, 2013, shall also be deemed a new admission under this rule.

Personal care services - assistance in performing the activities of daily living including toileting, dressing, and assistance with eating.

Program day - any day during which the day treatment program is in operation.

Provider - the individual, organization, or corporation, public or private, that provides day treatment program services and seeks reimbursement for providing those services under the Medicaid program.

Provider agreement - the agreement between the Department of Human Services and the provider of day treatment program services, specifying the services to be provided, methods of operation, a program statement, financial and legal requirements which must be met, and identification of the population to be served.

Qualified mental retardation professional - any of the following:

(a) A psychologist with at least a Master's Degree from an accredited program and with specialized training or a minimum of one (1) year of experience in a mental retardation program;

(b) A physician with specialized training in mental retardation or with a minimum of one (1) year of experience in treating the mentally retarded;

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

(d) A social worker with a Master's Degree from a school of social work accredited by the Council on Social Work Education (New York, New York), and with specialized training in mental retardation or with a minimum of one (1) year of experience in working with mentally retarded persons;

(e) A social worker with a Bachelor's Degree from an undergraduate social work program accredited by the Council on Social Work Education who is currently working and continues to work under the supervision of a social worker as defined in paragraph (d), and who has specialized training in mental retardation or a minimum of one (1) year of experience in working with mentally retarded persons;

(f) A rehabilitation counselor who is certified by the Commission on Rehabilitation Counselor Certification (Chicago, Illinois) and who has specialized training in mental retardation or a minimum of one (1) year of experience in working with mentally retarded persons;

(g) A physical therapist or occupational therapist with a Bachelor's Degree from an accredited program in physical or occupational therapy and who has specialized training or a minimum of one (1) year of experience in working with mentally retarded persons;

(h) A therapeutic recreation therapist who is a graduate of an accredited program and who has specialized training or a minimum of one (1) year of experience working with mentally retarded persons; and

(i) A registered professional nurse with a Master's Degree from an accredited school of nursing and with specialized training or a minimum of one (1) year of experience in working with mentally retarded persons.

Restorative services - physical, occupational, or speech therapies directly performed by a physical therapist, occupational therapist, or speech pathologist.

Site - The location of the day treatment program. If a day treatment provider operates a program in two (2) or more separate locations, each location is considered to be a separate site.

D.C. Mun. Regs. tit. 29, r. 29-799

Final Rulemaking published at 31 DCR 326 (January 27, 1984); as amended by Final Rulemaking published at 61 DCR 846 (January 31, 2014)

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. 774; 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.)).