Section 29-4209. REIMBURSEMENT:GENERAL

 

4209.1A home care agency seeking reimbursement for personal care aide services shall meet the conditions of participation for home health agencies set forth in 42 C.F.R. § 484, and shall comply with the requirements set forth in the Health-Care and Community Residence Facility Act, Hospice, and Home-Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code §§ 44-501 et seq.).

 

4209.2For dates of services beginning November 3 through December 31, 2015, each Provider shall be reimbursed five dollars ($5.00) per unit of service for allowable services in accordance with the Patient Protection and Affordable Care Act of 2010, approved March 23, 2010 (Pub. L. No. 111-148, 124 Stat. 119), as amended, and supplemented by the Health Care and Education Reconciliation Act of 2010, approved January 5, 2010 (Pub. L. No. 111-152, 124 Stat. 1029) and the District of Columbia Accrued Sick and Safe Leave Act of 2008, effective May 13, 2008 (D.C. Law 17-152; D.C. Official Code §§ 32-131.01 et seq.). The reimbursement rate includes administrative costs following the recent review of the FY 2013 Home Health Agencies cost reports. No less than three dollars and forty-five cents ($3.45) shall be paid to the PCA to comply with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01 et seq. (2012 Repl.)). 

 

4209.3For dates of services beginning January 1, 2016, each provider shall be reimbursed five dollars and two cents ($5.02) per unit for allowable services as authorized in the approved plan of care, of which no less than three dollars and forty-six cents ($3.46) per fifteen (15) minutes for services rendered by a PCA, shall be paid to the PCA to comply with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01 et seq. (2012 Repl.)). 

 

4209.4Subsequent changes to the reimbursement rate(s) shall be posted on the Medicaid fee schedule at www.dc-medicaid.com. DHCF shall also publish a notice in the D.C. Register which reflects the change in the reimbursement rate (s).

 

4209.5A unit of service for PCA services shall be fifteen (15) minutes spent performing allowable tasks. 

 

4209.6Reimbursement for personal care aide services shall not exceed sixteen (16) hours of service per day per recipient.

 

4209.7A provider of waiver services shall not bill the recipient or any member of the recipient’s family for personal care aide services.

 

4209.8DHCF may limit of deny services, if the cost of the services in addition to other home care services exceeds the estimated cost of institutional care.

 

 

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. 774; 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 50 DCR 9025 (October 24, 2003); as amended by Final Rulemaking published at 53 DCR 1696 (March 10, 2006); as amended by Final Rulemaking published at 61 DCR 6817 (July 4, 2014); as amended by Final Rulemaking published at 62 DCR 3939 (April 3, 2015); as amended by Final Rulemaking published at 63 DCR 6144 (April 22, 2016).