D.C. Mun. Regs. tit. 29, r. 29-9902

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

Rule 29-9902 - HOME HEALTH AIDE SERVICES

9902.1

Medicaid reimbursable Home Health Aide services are services that are required by a beneficiary due to an illness or injury, and include assistance with activities of daily living, assistance with self-administered medications, or other clinical tasks to assist with the provision of nursing or skilled services such as cleaning around a feeding tube and assistance with oxygen therapy, on a part-time or intermittent basis.

9902.2

In order to be eligible for Medicaid reimbursement, a Home Care agency providing Home Health Aide services shall meet all requirements of Subsection 9901.2.

9902.3

Medicaid reimbursable Home Health Aide services shall be provided by a home health aide certified in accordance with Chapter 93 (Home Health Aides) of Title 17 DCMR, who is supervised in accordance with 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.) and implementing rules.

9902.4

Medicaid reimbursable Home Health Aide services shall consist of the following duties:

(a) Performing personal care including assistance with activities of daily living such as bathing, personal hygiene, toileting, transferring from the wheelchair, and instrumental activities such as meal preparation, laundry, grocery shopping, and telephone use;

(b) Changing urinary drainage bags;

(c) Assisting the beneficiary with transfer, ambulation, and exercise as prescribed;

(d) Assisting the beneficiary with self-administration of medication;

(e) Measuring and recording temperature, pulse, respiration, and blood pressure;

(f) Measuring and recording height and weight;

(g) Observing, recording, and reporting the beneficiary's physical condition, behavior, or appearance;

(h) Preparing meals in accordance with dietary guidelines;

(i) Assisting with skills necessary for food consumption;

(j) Implementing universal precautions to ensure infection control;

(k) Performing tasks related to keeping the beneficiary's living area in a condition that promotes the beneficiary's health and comfort;

(l) Changing simple dressings that do not require the skills of a licensed nurse;

(m) Assisting the beneficiary with activities that are directly supportive of skilled therapy services;

(n) Assisting with routine care of prosthetic and orthotic devices

(o) Emptying and changing colostomy bags and performing care of the stoma;

(p) Cleaning around a gastrostomy tube site;

(q) Administering an enema; and

(r) Assisting with oxygen therapy.

9902.5

Home Health Aide services shall be reimbursed by Medicaid for up to four (4) hours per day with prior authorization by DHCF, in accordance with the requirements set forth under Subsection 9902.6. The need for continuing Home Health Aide services shall be reassessed and certified by the physician every sixty (60) days.

9902.6

A beneficiary and his/her physician shall obtain prior authorization for the initiation of Medicaid reimbursable Home Health Aide services by submitting a physician's order as described in Section 9900 to DHCF or its agent to support the beneficiary's need for Home Health Aide services which aligns with the beneficiary's assessed needs.

9902.7

The Home Care agency shall initiate Home Health Aide services no later than twenty-four (24) hours after completing the plan of care, as described in Subsection 9900.11, unless the beneficiary's health or safety warrants the need for more immediate service initiation or the beneficiary or beneficiary's representatives agree to begin the services at a later date.

9902.8

The Home Care agency shall obtain prior authorization for continuing Medicaid reimbursable Home Health Aide services every sixty (60) calendar days by submitting an updated physician's order and any supporting documentation to DHCF or its agent to support the beneficiary's need for ongoing Home Health Aide services which aligns with the beneficiary's assessed needs, as outlined in the updated plan of care.

9902.9

DHCF may authorize additional hours of Medicaid reimbursable Home Health Aide services above the four (4) hour per day limit for a beneficiary if DHCF determines that:

(a) Additional hours are medically necessary as reflected on the physician's order described in Subsections 9900.7 through 9900.9;

(b) The beneficiary's needs can be safely met in the home; and

(c) The beneficiary's Medicaid-funded services are being delivered in a cost effective manner appropriate to the beneficiary's level of care.

9902.10

For dates of service beginning on or after July 1, 2021, fee schedules rates shall be the same for both governmental and private providers of Home Health Aide services, unless noted otherwise in the Medicaid State Plan, and shall comply with fee schedule rates published on the Medicaid website at https://www.dcmedicaid.com/dcwebportal/home.

9902.11

For dates of service beginning on or after October 1, 2017, reimbursement rates for Home Health Aide services, as authorized in the approved plan of care, shall be adjusted annually with the Living Wage rates published by the District of Columbia, Department of Employment Services. The rates and adjustments for Home Health Aide services shall be paid in compliance with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§2220.01et seq.).

9902.12

For dates of service beginning on or after October 1, 2017, the reimbursements rates for Skilled Nursing Services shall be adjusted annually using the Medicare Economic Index factor for skilled nursing published by the Centers for Medicare and Medicaid Services.

9902.13

All changes to reimbursement rate(s) shall be posted on the Medicaid fee schedule at https://www.dc-medicaid.com/dcwebportal/home and DHCF shall also publish a notice in the District of Columbia Register which reflects the change in the reimbursement rate(s).

D.C. Mun. Regs. tit. 29, r. 29-9902

Final Rulemaking published at 64 DCR 418 (1/19/2018); amended by Final Rulemaking published at 70 DCR 9779 (7/14/2023)