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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-19. HOME AND COMMUNITY-BASED SERVICES WAIVER FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES |
Section 29-1924. FAMILY TRAINING SERVICES
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1924.1This section shall establish conditions of participation for Medicaid providers enumerated in § 1924.9 (“Medicaid Providers”) and family training services professionals enumerated in § 1924.8 (“professionals”) to provide family training services to caregivers of persons enrolled in the Home and Community-Based Services Waiver for Persons with Intellectual and Developmental Disabilities (ID/DD Waiver).
1924.2 Family training services are training, counseling, and other professional support services offered to uncompensated caregivers who provide support, training, companionship, or supervision to persons enrolled in the ID/DD Waiver.
1924.3 Uncompensated caregivers include any family member, neighbor, friend, companion, or co-worker who regularly provides uncompensated care to the person.
1924.4In order to be eligible for reimbursement, each Medicaid provider must obtain prior authorization from the Department on Disabilities Services (DDS) prior to providing, or allowing any professional to provide, family training services. In its request for prior authorization, the Medicaid provider shall document the following:
(a) The ID/DD Waiver participant’s need for additional, uncompensated support;
(b) The family training services professional who will provide the family training services; and
(c) The individual caregivers who will receive the family training services.
1924.5In order to be eligible for Medicaid reimbursement, each family training services professional shall conduct an assessment of family training needs within the first four (4) hours of service delivery, and shall develop a training plan with training goals and techniques that will assist the ID/DD Waiver participant’s unpaid caregivers. The training plan shall include measurable outcomes and a schedule of approved family training services to be provided, and shall be submitted by the Medicaid provider to DDS before services are delivered.
1924.6In order to be eligible for Medicaid reimbursement, each Medicaid provider shall document the following in the ID/DD Waiver participant’s Individual Support Plan (ISP) and Plan of Care:
(a) The date and amount of family training services provided;
(b) The nature of the family training services provided;
(c) The professional who provided the family training services; and
(d) The individual caregivers who received the family training services.
1924.7Medicaid reimbursable family training services shall include the following activities:
(a) Instruction about treatment regimens and other services included in the person’s ISP and Plan of Care;
(b) Instruction on the use of equipment specified in the person’s ISP and Plan of Care;
(c) Counseling aimed at assisting the unpaid caregiver in meeting the needs of the person; and
(d) Follow up training necessary to safely maintain the person at home.
1924.8 Medicaid reimbursable family training services shall be provided by the following professionals:
(a) Special Education Teachers;
(b) Licensed Graduate Social Workers;
(c) Licensed Clinical Social Workers;
(d) Physical Therapists;
(e) Occupational Therapists;
(f) Registered Nurses; or
(g) Speech Pathologists.
1924.9In order to be eligible for Medicaid reimbursement, each family training services professional shall be employed by the following Medicaid providers:
(a) An ID/DD Waiver Provider enrolled by DDS; or
(b) A Home Health Agency as defined in Section 1999 of Chapter 19 of Title 29 of the DCMR.
1924.10Each Medicaid provider shall comply with Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 of the DCMR.
1924.11Each Medicaid provider shall maintain the following documents for monitoring and audit reviews:
(a) A copy of the most recent DDS approved ISP and Plan of Care, which shall include the documentation required by § 1924.6;
(b) The training plan developed in accordance with the requirements of § 1924.5 ; and
(c) The documents required to be maintained under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 of the DCMR.
1924.12Each Medicaid provider shall comply with Section 1908 (Reporting Requirements) and Section 1911 (Individual Rights) of Chapter 19 of Title 29 of the DCMR.
1924.13 Medicaid reimbursement shall not be available when family training services that are included in a person’s ISP are provided concurrently with the following ID/DD Waiver services:
(a)Supported living and supported living with transportation, with the exception of family training services which may be provided to uncompensated caregivers for people receiving supported living periodic or supported living with transportation periodic services;
(b)Residential habilitation; or
(c)Host home without transportation.
1924.14Medicaid reimbursable family training services shall not exceed a total of four (4) hours per day and one hundred (100) hours per year. Any hours in excess of these limits must be pre-approved by DDS pursuant to § 1924.15.
1924.15In order to be eligible for Medicaid reimbursement, professionals requesting pre-approval from DDS to provide family training services in excess of four (4) hours per day and one hundred (100) hours per year must demonstrate the need for such services. The decision of DDS to approve or disapprove the request for additional services, in whole or in part, shall be final.
1924.16 The Medicaid reimbursement rate for family training services shall be sixty-one dollars ($61.00) per hour, or fifteen dollars and twenty-five cents ($15.25) per unit. The billable unit of service for family training services shall be fifteen (15) minutes.