Section 29-1902. ELIGIBILITY REQUIREMENTS

 

1902.1 Any person eligible to receive Waiver services shall be a person who currently receives services from DDS/DDA and meets all of the following requirements:

 

(a)Has a special income level up to three hundred percent (300%) of the SSI federal benefit or be aged and disabled with income up to one hundred percent (100%) of the federal poverty level or be medically needy as set forth in 42 C.F.R. §§ 435.320, 435.322, 435.324 and 435.330;

 

(b)Has an intellectual disability as defined in D.C. Official Code § 7-1301.03(15A), which, when establishing qualifying intelligence quotient (IQ), includes consideration of the standard error of measurement associated with the particular IQ test, and requires adaptive deficits across at least two of the following three domains: conceptual, practical, and social;

 

(c)Is eighteen (18) years of age or older;

 

(d)Is a resident of the District of Columbia as defined in D.C. Official Code § 7-1301.03(22);

 

(e)Has a Level of Care (LOC) determination that the person requires services furnished in an Intermediate Care Facility for Individuals with Intellectual  Disabilities (ICF/IID) or be a person with related conditions pursuant to the criteria set forth in § 1902.4; and

 

(f)Meets all other eligibility criteria applicable to Medicaid recipients including citizenship and alienage requirements.

 

1902.2 Waiver services shall not be furnished to a person who is an inpatient of a hospital, ICF/IID, or nursing facility.

 

1902.3 Each person enrolled in the Waiver shall be re-certified annually as having met all of the eligibility requirements as set forth in § 1902.1 for continued participation in the Waiver.

 

1902.4A person shall meet the LOC determination set forth in § 1902.1(e) if one of the following criteria has been met, taking into consideration the standard error of measurement for the IQ test:

 

(a)The person’s primary disability is an intellectual disability with an intelligence quotient (IQ) of fifty-nine (59) or less;

 

(b)The person’s primary disability is an intellectual disability with an IQ of sixty (60) to sixty-nine (69) and the person has at least one (1) of the following additional conditions:

 

(1)Mobility deficits;

(2)Sensory deficits;

(3)Chronic health problems;

(4)Behavior problems;

(5)Autism;

(6)Cerebral Palsy;

(7)Epilepsy; or

(8)Spina Bifida.

 

(c)The person’s primary disability is an intellectual disability with an IQ of sixty (60) to sixty-nine (69) and the person has severe functional limitations in at least three (3) of the following major life activities:

 

(1)Self-care;

(2)Understanding and use of language;

(3)Functional academics;

(4)Social skills;

(5)Mobility;

(6)Self-direction;

(7)Capacity for independent living; or

(8)Health and safety.

 

(d) The person has an intellectual disability, has severe functional limitations in at least three (3) of the major life activities as set forth in § 1902.4(c)(1) through § 1902.4(c)(8), and has one (1) of the following diagnoses:

(1) Autism;

(2) Cerebral Palsy;

(3) Prader Willi; or

(4) Spina Bifida.

 

authority

An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 744; D.C. Official Code § 1-307.02 (2012 Repl. & 2013 Supp.)) and Section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2012 Repl.)).

source

Final Rulemaking published at 51 DCR 10207 (November 5, 2004); as amended by Final Rulemaking published at 61 DCR 4406 (May 2, 2014); as amended by Final Rulemaking published at 63 DR 10445 (August 12, 2016).