D.C. Mun. Regs. tit. 29, r. 29-9028

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

Rule 29-9028 - PERSONAL CARE SERVICES

9028.1

The purpose of this section is to establish standards governing Medicaid eligibility for personal care services for individuals enrolled in the IFS Waiver and to establish conditions of participation for providers of personal care services.

9028.2

Personal care services are identical in scope to those described in 29 DCMR § 5000. Personal care services may be delivered at home, in the day setting, at school or work, or in the community.

9028.3

To be eligible for Medicaid reimbursement for personal care services under the IFS Waiver, the person shall:

(a) Exhaust all available personal care services provided under the State Plan for Medical Assistance (Medicaid State Plan) prior to receiving personal care services under the IFS Waiver;

(b) Be unable to independently perform one or more activities of daily living for which personal care services are needed;

(c) Be in receipt of a written order for PCA services by a physician in accordance with § 5006.1 and 5006.2 of Title 29 DCMR; and

(d) Be authorized for personal care services based on a comprehensive assessment of the person's support needs and risk screening using the DDA Level of Need Assessment and Screening Tool (LON), or its successor, and reflected in the person's ISP and Plan of Care.

9028.4

Persons eligible for personal care services under the IFS Waiver shall be exempt from the requirement to obtain an authorization for services from DHCF or its agent under Section 5003 of Chapter 50 of Title 29 DCMR.

9028.5

Personal care services eligible for Medicaid reimbursement shall include, but not be limited to the activities identified under § 5006.7 of Chapter 50 of Title 29 DCMR.

9028.6

Medicaid reimbursable personal care services shall not include:

(a) Services that require the skills of a licensed professional as defined by the District of Columbia Health Occupations Revision Act of 1985, as amended, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq.);

(b) Tasks usually performed by chore workers or homemakers, such as cleaning of areas not occupied by the beneficiary and shopping for items not used by the person receiving services; and

(c) Money management.

9028.7

Personal care services delivered by a personal care aide shall be supervised by a registered nurse. The registered nurse shall review the person's health management care plan, if available, in order to make the initial assessment for personal care services

9028.8

The registered nurse shall conduct an initial assessment with the person enrolled in the IFS Waiver within seventy-two (72) hours of receiving authorization for personal care services from DDS.

9028.9

A plan of care for the delivery of personal care services shall be developed in accordance with § 5005.2 of Chapter 50 of Title 29 DCMR.

9028.10

In order to be eligible for Medicaid reimbursement for personal care services, the provider shall review the plan of care at least once every sixty (60) days, and shall update or modify the plan of care as needed. The registered nurse shall notify the person's physician of any significant change in the beneficiary's condition.

9028.11

If an update or modification to the plan of care requires any change in the frequency, duration, or scope of personal care services provided to the person enrolled in the IFS Waiver, the provider shall obtain an updated authorization for personal care services from DDS in accordance with § 9028.3(d).

9028.12

To be eligible for Medicaid reimbursement for personal care services, a provider shall:

(a) Be a home care agency licensed pursuant to the requirements for home care agencies as set forth in the Health Care and Community Residence Facility, Hospice and Home Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code §§ 44-501et seq. (2012 Repl.)), and implementing rules;

(b) Be enrolled as a Medicare home health agency qualified to offer skilled services as set forth in Sections 1861(o) and 1891(e) of the Social Security Act and 42 CFR § 484;

(c) Comply with the requirements under Section 9010 (Provider Qualifications) and 9009 (Provider Enrollment Process) of Chapter 90 of Title 29 DCMR; and

(d) Comply with all of the requirements for Medicaid State Plan personal care service providers.

9028.13

A home care agency shall meet the requirements described under Section 5008 (Staffing) and Section 5010 (Staffing Agencies) of Chapter 50 of Title 29 of the DCMR.

9028.14

In order to be eligible for Medicaid reimbursement, each DSP including personal care aides providing personal care services shall comply with Section 9011 (Requirements of Direct Support Professionals) of Chapter 90 of Title 29 DCMR.

9028.15

In order to be eligible for Medicaid reimbursement, each personal care services provider shall comply with the requirements described under Section 9013 (Reporting Requirements) and Section 9005 (Individual Rights) of Chapter 90 of Title 29 DCMR.

9028.16

In order to be eligible for Medicaid reimbursement, each personal care services provider shall comply with the record maintenance requirements described under Section 9006 (Records and Confidentiality of Information) of Chapter 90 of Title 29 DCMR, and Section 5013 of Chapter 50 of Title 29 DCMR.

9028.17

In order to be eligible for Medicaid reimbursement, each provider of personal care services shall comply with the denial, suspension, reduction or termination of services requirements under Section 5007 of Chapter 50 of Title 29 DCMR.

9028.18

In order to be eligible for Medicaid reimbursement, each provider of personal care services shall develop contingency staffing plans to provide coverage for a person receiving personal care services if the assigned personal care aide cannot provide the service or is terminated by the provider.

9028.19

If person receiving personal care services seeks to change providers, the DDS service coordinator shall assist the person in selecting a new provider. In order to be eligible for Medicaid reimbursement for personal care services, the current provider shall continue to provide services until the transfer to the new provider has been completed.

9028.20

Personal care services shall not be provided in a hospital, nursing facility, intermediate care facility, or other living arrangement that includes personal care as part of the reimbursed service.

9028.21

Personal care services may be provided by family members other than the person's spouse, parent, guardian, or any other individual legally responsible for the person receiving services who ordinarily would perform or be responsible for performing services on the person's behalf.

9028.22

Family members who provide personal care services, except for those listed under § 9028.21, shall meet the requirements for DSPs referenced under § 9028.14.

9028.23

The Medicaid reimbursement rate for personal care services shall be the same as the rate listed in § 5015.1 (Reimbursement) of Chapter 50 (Medicaid Reimbursement for Personal Care Aide Services) of Title 29 (Public Welfare) of the DCMR.

D.C. Mun. Regs. tit. 29, r. 29-9028

Final Rulemaking published at 69 DCR 10229 (8/12/2022)