D.C. Mun. Regs. tit. 5, r. 5-A2834

Current through Register Vol. 71, No. 43, October 25, 2024

Rule 5-A2834 - MEDICAID

2834.1

A nonpublic special education school or program shall adhere to all federal and District of Columbia laws and regulations governing Medicaid reimbursable services, including, but not limited to, documentation of all instances of IEP health-related services delivered to District of Columbia students.

2834.2

A nonpublic special education school, program or related service provider shall keep organized and confidential records that detail client specific information regarding all specific Medicaid reimbursable services provided for each individual recipient of services and retain those records for review. All such documentation shall include with the invoice:

(a) Recipient's name, date of birth, and Medicaid or unique identification number;

(b) Date, start time, and location of the services;

(c) Service Provider name and contact information;

(d) A description of the services provided, including diagnosis code and level of service;

(e) Duration (or unit) of service, with start time;

(f) Therapy modality (individual or group, including the size of the group);

(g) Dated progress notes with an original signature by the service provider, including credentials (and signature of qualified supervisors for service providers requiring supervision);

(h) A copy of provider health evaluation(s) and assessments(s);

(i) A copy of the current IEP authorizing related service(s);

(j) Individual service provider daily documentation of the nature of the service encounters and progress notes, signed and dated by the provider, and listing the provider's credentials; and

(k) An attendance report including specific days of attendance and absence (identified as excused and unexcused) for each student included in an invoice.

2834.3

The frequency, duration and scope of services shall be specified in the student's IEP consistent with the IDEA and its implementing regulations.

2834.4

All services shall be documented within fifteen (15) calendar days of delivery and submitted with invoices using the format required by the District of Columbia. .

2834.5

As requested by OSSE, a nonpublic special education school or program shall enter into a contract confirming its rates for Medicaid purposes and consistent with the Placement Act requirements.

2834.6

An LEA shall give placement preference to a Psychiatric Residential Treatment Facility (PRTF) that meets the District of Columbia Department of Health Care Finance (DHCF) standards and requirements specified in 29 DCMR § 948. It is the responsibility of the LEA, with the consent of the child's parent pursuant to 34 C.F.R. § 300.154(2010), to contact DHCF to determine whether the child is eligible or entitled to Medicaid benefits and should request a certification from the District of Columbia Department of Mental Health (DMH) stating that admission to a PRTF is medically necessary under 29 DCMR § 948.7.

D.C. Mun. Regs. tit. 5, r. 5-A2834

Final Rulemaking published at 57 DCR 9444, 9466 (October 8, 2010); as amended by Notice of Final Rulemaking published at 58 DCR 5442, 5448 (July 1, 2011)

5 DCMR A § 2834 was originally published in chapter 28 (Certification of Approval for Nonpublic Special Education Schools and Programs Serving Students with Disabilities Funded by the District of Columbia and Special Education Rates. The title to chapter 28 was amended to "Nonpublic Special Education Schools and Programs Serving Students with Disabilities Funded by the District of Columbia and Special Eucation Rates" by Notice of Final Rulemaking published at 58 DCR 5442 (July 1, 2011).

Authority: The State Superintendent of Education, pursuant to the authority set forth in sections 3(b)(8) and (11) of the State Education Office Establishment Act of 2000, effective October 21, 2000 (D.C. Law 13-176; D.C. Official Code § 38-2602(b)(8) and (11)) (Supp. 2010.); sections 101 et seq. of the Placement of Students with Disabilities in Nonpublic Schools Amendment Act of 2006, effective March 14, 2007 (D.C. Law 16-269; D.C. Official Code §§ 38-2561.01, et seq.) (Supp. 2010); Mayor's Order 2007-149 (June 28, 2007); and Article II of An Act to provide for compulsory school attendance, and for other purposes, approved February 4, 1925 (43 Stat. 805; D.C. Official Code §§ 38-202 et seq.) (2001 & Supp. 2010).