D.C. Mun. Regs. tit. 29, r. 29-7420
Effective April 1, 2022, the District shall establish a per member per month (PMPM) rate to reimburse HSS providers for the provision of HSS delivered to individuals enrolled in the DC Medicaid program using a PMPM payment structure. The PMPM rate shall be determined in accordance with 29 DCMR §§ 103.3.
The HSS PMPM reimbursement rate shall be seven hundred and fifty-five dollars and twenty-one cents ($755.21). Upon the launch of the HSS benefit, this rate, and any amendments to this rate, will be published on the DHCF website at www.dc-medicaid.com and in accordance with 29 DCMR §§ 988.4.
The Department shall reimburse HSS providers, using a PMPM payment structure, for the provision of PSH services to individuals that are not eligible for enrollment in the District Medicaid HSS program, or that temporarily lose their Medicaid enrollment status. The PMPM rate paid by the Department shall equal the rate described above at §§7420.2 and in accordance with 29 DCMR §§ 988.4.
The Department shall reimburse HSS providers for the provision of adjunct services that facilitate the provision of HSS and promote the housing stability of adult individuals on a monthly basis. The reimbursement rates for each type of service are detailed below or in the Department's HCA with the HSS provider:
To be eligible for a PMPM payment for PSH services for an individual receiving Housing Navigation Services, a PSH provider shall deliver any service listed at §§ 7403 of this Chapter at a minimum frequency of once a week within the month. At least two (2) of these services shall be delivered face-to-face with the client. The other contacts may be made by telephone, email, text, or another electronic format.
To be eligible for a PMPM payment for PSH services for an individual receiving Housing Stabilization Services, a PSH provider shall deliver any service listed at §§ 7404 of this Chapter at a minimum frequency of twice a month. At least one of these services shall be delivered face-to-face with the client. The other contact may be made by telephone, email, text, or another electronic format.
To receive a PMPM payment for PSH services delivered to minors in the eligible individual's household, the HSS provider shall provide services at the scope and frequency described in the HSS provider's HCA with the Department.
For individuals not eligible for reimbursement through the District's Medicaid program, each HSS provider shall submit a monthly invoice to the Department for reimbursement within thirty (30) days of the date of service or of the date a Medicaid claim is denied for the same date of service.
Reimbursement to an HSS provider for the provision of HSS to individuals participating in the DC Medicaid HSS benefit shall be in accordance with Chapter 103 (Medicaid Reimbursement for Housing Supportive Services), to Title 29 (Public Welfare), of the District of Columbia Municipal Regulations (DCMR).
An HSS provider's submission of an invoice to the Department for PSH delivered to an adult individual will serve as the HSS provider's attestation that avenues for Medicaid reimbursement for the services have been exhausted, and that the HSS provider has followed all necessary procedures and policies for supporting the individual's initial and continued enrollment in the District's Medicaid program.
An HSS provider shall not submit an invoice to the Department for a Medicaid claim that is not submitted or denied because the submission was unacceptable or untimely.
An HSS provider shall be eligible to receive one PMPM rate for HSS services provided to an adult individual, and, if applicable, one additional PMPM rate for PSH services provided to minors within the adult individual's household.
Any claim submitted to Medicaid for reimbursement or invoice submitted to DHS for reimbursement for program services shall be supported by written documentation in the individual's record in the Department's case note system, according to the standards described in this Chapter.
D.C. Mun. Regs. tit. 29, r. 29-7420