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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 29-71. MEDICAID REIMBURSEMENT FOR EARLY INTERVENTION SERVICES |
Section 29-7100. EARLY INTERVENTION SERVICES: GENERAL AND SPECIFIC STANDARDS
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7100.1 Early Intervention (EI) services are specialized habilitative and rehabilitative services designed to promote the optimal development of infants and toddlers, aged birth to three, who have a delay in one or more areas of development. EI services are required under Part C of the Individuals with Disabilities Education Act (IDEA) (20 U.S.C. §§ 1400 et seq.).
7100.2The Office of the State Superintendent of Education (OSSE) is the Lead Agency responsible for administering EI services to eligible infants and toddlers in the District of Columbia under Part C of the IDEA. The Department of Health Care Finance (DHCF) is the single state agency responsible for administering the Medicaid program under Title XIX of the Social Security Act (42 U.S.C. § 1396).
7100.3DHCF will reimburse the Lead Agency for EI services provided to Medicaid beneficiaries in accordance with the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit and the requirements set forth in these rules.
7100.4 The Lead Agency shall be the qualified Medicaid enrolled provider for EI services and shall ensure the following:
(a) A multidisciplinary evaluation and assessment of the child’s level of functioning as described in 34 C.F.R. § 303.371, in the following developmental areas:
(1) Cognitive development;
(2) Physical development, including vision, and hearing;
(3) Communication development;
(4) Social or emotional development; and
(5) Adaptive development.
(b) Consultation with the child’s parent, authorized caregiver, or other service provider;
(c) Evaluation of the family’s capacity to meet the developmental needs of the child;
(d) Development, review and evaluation of the child’s Individualized Family Service Plan (IFSP) as described in 34 C.F.R §§ 303.342-303.344, which shall include initial and subsequent plans of care, assessments for services, IFSP team orders, medical conditions, functional losses, other pertinent documentation of the beneficiary’s progress or lack of progress, and treatment goals and services provided in order to demonstrate that EI Services are reasonable and necessary;
(e) Service coordination as described in 34 C.F.R. § 303.34;
(f) Receipt of contact information for the child and their parent or other authorized caregiver;
(g) Completion of screenings pursuant to the Criminal Background Checks for the Protection of Children Act of 2004, effective April 13, 2005 (D.C. Law 15-353; D.C. Official Code §§ 4-1501.01 et seq.) and, if applicable, shall comply with any background check requirements established by the Department of Health Care Finance (DHCF) and/or the Lead Agency;
(h) On-site inspections to be conducted by the Centers for Medicare and Medicaid Services (CMS) and DHCF to determine provider compliance with all applicable laws; and
(i) Maintenance of documentation for at least ten (10) years from service initiation.
7100.5DHCF will reimburse the Lead Agency for EI services provided to eligible Medicaid beneficiaries who are enrolled in the fee-for-service program, and have been assessed, pursuant to § 7100.4(a), and found to meet one (1) or more of the following requirements:
(a) Has a fifty-percent (50%) developmental delay in one (1) or more of the following areas:
(1) Cognitive development;
(2) Physical development, including vision and hearing;
(3) Communication development;
(4) Social or emotional development; or
(5) Adaptive development;
(b) Has a diagnosed physical or mental condition that has a high probability of resulting in a significant developmental delay; or
(c) Has a twenty-five percent (25%) developmental delay in two (2) or more of the following areas:
(1) Cognitive development;
(2) Physical development, including vision and hearing;
(3) Communication development;
(4) Social or emotional development; or
(5) Adaptive development.
7100.6Transportation services for EI services shall be provided in accordance with the contract between DHCF and the District’s Medicaid Non-Emergency Transportation Broker.
7100.7 Beginning on July 1, 2014, and in accordance with 34 C.F.R. § 303.211, Medicaid reimbursement for children who are eligible for preschool services under § 619 of Part B of IDEA (20 U.S.C. § 1419) and previously receiving EI services may continue after a child turns three (3) until the beginning of the school year following the child’s fourth (4th) birthday.
7100.8 The continuation of Medicaid reimbursement for EI services under Part C of IDEA for eligible children with disabilities is available from age three (3) until the first year for which the child enters or is eligible under District of Columbia law to enter pre-kindergarten or elementary school. The continuation of EI services shall not be provided beyond the age at which the child actually enters, or is eligible under District of Columbia law to enter pre-kindergarten or elementary school.
7100.9 Medical and health services shall be reimbursed by DHCF under the authority of the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services benefit subject to any requirements set forth in the State Plan, implementing rules, and any subsequent amendments thereto.
7100.10 EI Services that are eligible for Medicaid reimbursement shall include the following:
(a) Assistive technology devices and services as described in 34 C.F.R. § 303.13(b)(1);
(b) Audiology services as described in 34 C.F.R. § 303.13(b)(2);
(c) Developmental therapy, also known as Special Instruction as described in 34 C.F.R. § 303.13(b)(14);
(d) Nursing services as described in 34 C.F.R. § 303.13(b)(6);
(e) Nutrition services as described in 34 C.F.R. § 303.13(b)(7);
(f) Occupational therapy as described in 34 C.F.R. § 303.13(b)(8);
(g) Physical therapy as described in 34 C.F.R. § 303.13(b)(9);
(h) Psychological services as described in 34 C.F.R. § 303.13(b)(10);
(i) Social work services as described in 34 C.F.R. § 303.13(b)(13);
(j) Speech-language pathology as described in 34 C.F.R. § 303.13(b)(15); and
(k) Vision services as described in 34 C.F.R. § 303.13(b)(17).
7100.11 In accordance with 20 USC § 1432(4)(G), to the maximum extent appropriate, EI services shall be provided in natural environments, including the home and community settings in which children without disabilities participate.