D.C. Mun. Regs. tit. 29, r. 29-9001

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-9001 - COVERED SERVICES AND RATES

9001.1

Services available under the IFS Waiver shall include the following:

(a) Assistive Technology Services, 29 DCMR §§ 9015;

(b) Behavioral Support Services, 29 DCMR §§ 9016;

(c) Companion Services, 29 DCMR §§ 9017;

(d) Creative Arts Therapies Services, 29 DCMR §§ 9018;

(e) Day Habilitation Services, 29 DCMR §§ 9019;

(f) Personal Emergency Response System (PERS), 29 DCMR §§ 9020;

(g) Education Support Services, 29 DCMR §§ 9021;

(h) Employment Readiness Services, 29 DCMR §§ 9022;

(i) Family Training Services, 29 DCMR §§ 9023;

(j) Individualized Day Supports Services, 29 DCMR §§ 9024;

(k) In-Home Supports Services, 29 DCMR §§ 9025;

(l) Occupational Therapy Services, 29 DCMR §§ 9026;

(m) Parenting Support Services, 29 DCMR §§ 9027;

(n) Personal Care Services, 29 DCMR §§ 9028;

(o) Physical Therapy Services, 29 DCMR §§ 9029;

(p) Respite Services, 29 DCMR §§ 9030;

(q) Skilled Nursing Services, 29 DCMR §§ 9031;

(r) Speech, Hearing, and Language Services, 29 DCMR §§ 9032;

(s) Supported Employment Services - Individual and Small Group Services, 29 DCMR §§ 9033;

(t) Wellness Services, 29 DCMR §§ 9034;

(u) Individual-Directed Goods and Services, 29 DCMR §§ 9035; and

(v) Remote Supports Services, 29 DCMR §§ 9036.

9001.2

The Medicaid provider reimbursement rate(s) to be paid for the Waiver services identified in §§ 9001.1 shall be posted on the District of Columbia Medicaid fee schedule at www.dc-medicaid.com . DHCF shall also publish a notice in the D.C. Register which reflects the change in the reimbursement rate(s) for Waiver services.

9001.3

No Waiver provider shall provide Waiver services unless in receipt of a Service Authorization from DDS, Developmental Disabilities Administration (DDS/DDA), for that Waiver service. A Service Authorization is an approval for a prescribed Waiver service issued by DDS/DDA to the provider prior to rendering service and is located on MCIS, DDS/DDA's case management information system, or its successor. DDS/DDA will not retroactively authorize services, except in the event of an emergency in which the provider has notified DDS and provided the services in good faith to avoid any service disruptions for the person, and subject to the approval of the Deputy Director for DDA.

9001.4

DHCF shall not reimburse any Waiver provider for services if the provider:

(a) Fails to comply with any applicable regulation in this chapter;

(b) Fails to comply with all applicable federal and District of Columbia laws and regulations;

(c) Fails to comply with all applicable transmittals, rules, manuals and other requirements for payment issued by DHCF;

(d) Provides services in the absence of an approved prior authorization from DHCF or its designee for payment identifying the authorized service, number of hours or units authorized, duration, and scope of service; or

(e) Fails to comply with the terms of the Medicaid Provider Agreement.

9001.5

Each Waiver provider shall agree to accept, as payment in full, the amount determined by DHCF as reimbursement for the authorized Waiver services provided to beneficiaries.

9001.6

Each Waiver provider shall agree to bill any and all known third-party payers prior to billing Medicaid.

9001.7

A standard unit of fifteen (15) minutes requires that the provider provide a minimum of eight (8) minutes of service in a span of fifteen (15) continuous minutes in order to be billed as a unit of service.

D.C. Mun. Regs. tit. 29, r. 29-9001

Final Rulemaking published at 69 DCR 10229 (8/12/2022); amended by Final Rulemaking published at 71 DCR 10475 (8/23/2024)