Section 29-9721. SERVICE LIMITATIONS

 

9721.1A person shall not receive ADHP services if they reside in an institutional setting or any setting that is not in compliance with the HCBS setting requirements consistent with 42 C.F.R. § 441.301 and 42 C.F.R. § 441.710.

9721.2A provider shall not be reimbursed for ADHP services under these rules if the participant is concurrently receiving the following services:

 

(a) Day Habilitation and Individualized Day Supports under the Section 1915 (c) Waiver for Individuals with Intellectual and Developmental Disabilities (ID/DD);

 

(b) Intensive day treatment or day treatment mental health rehabilitative services (MHRS);

 

(c) Personal Care Aide (PCA) services  (State Plan and 1915 (c) waivers); or

 

(d) Adult day care or day services funded by the Older Americans Act of 1965, approved July 14, 1965 (Pub. L. No. 89-73, 79 Stat. 218), as amended by the Older Americans Act Amendments of 2000, approved November 13, 2000 (Pub. L. No. 106-501, 114 Stat. 2226), as amended by the  Older Americans Act Amendments of 2006, approved October 17, 2006 (Pub. L. No. 109-365, 120 Stat. 2522).

 

9721.3DHCF shall not reimburse ADHP services if the participant is also receiving or being billed for the services listed under sub-section 9721.2 at the same time the participant is in attendance at the ADHP site.

 

9721.4A provider shall not be reimbursed for ADHP services if the participant is receiving intensive day treatment mental health rehabilitation services during a twenty-four (24) period that immediately precedes or follows the receipt of ADHP services, to ensure that the participant is receiving services in the setting most appropriate to his/her clinical needs.

 

9721.5If a person is also receiving Personal Care Aide (PCA) services under the State Plan for Medical Assistance on the same day that ADHP services are delivered, the combination of both PCA and ADHP services shall not exceed a total of twelve (12) hours per day.

 

9721.6ADHP services shall not be provided for more than five (5) days per week and for more than eight (8) hours per day.

 

 

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 (2014 Repl.)), 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 63 DCR 1031 (January 29, 2016).