5916338 Health Care Finance, Department of - Notice of Emergency and Proposed Rulemaking - Governing Individualized Day Supports for Participants enrolled in the Home and Community- Based Services Waiver for Individuals with Intellectual and ...

DEPARTMENT OF HEALTH CARE FINANCE

NOTICE OF EMERGENCY AND PROPOSED RULEMAKING

The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in 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 (2014 Repl. & 2015 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.)), hereby gives notice of the adoption, on an emergency basis, of amendments to Section 1925, entitled “Individualized Day Supports,” of Chapter 19 (Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities) of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (DCMR). 

 

These emergency and proposed rules change the reimbursement rate for individualized day supports services provided to participants in the Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (ID/DD Waiver).

 

The ID/DD Waiver was approved by the Council of the District of Columbia (Council) and renewed by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) for a five-year period beginning November 20, 2012. The corresponding amendment to the ID/DD Waiver was approved by the Council through the Medicaid Assistance Program Amendment Act of 2014, effective February 26, 2015 (D.C. Law 20-155; D.C. Official Code § 1-307.02(a)(8)(E) (2014 Repl. & 2015 Supp.)). CMS approved the amendment to the ID/DD Waiver effective September 24, 2015.

 

Individualized day supports services provide crucial habilitation supports in the community to ensure that a person’s community integration is increased and the particular skills necessary for independence and community involvement outside the home are developed and maintained in ways that enhance community integration outcomes. The most recent Notice of Final Rulemaking for 29 DCMR § 1925 (Individualized Day Supports) was published in the D.C. Register on January 1, 2016, at 63 DCR 000050. This emergency and proposed rulemaking amends the previously published final rulemaking by changing the reimbursement rates in Subsection 1925.23.  Emergency action is necessary for the immediate preservation of the health, safety, and welfare of Waiver participants who are in need of these services as the rates must be increased to correspond with Waiver Year 4. 

 

The emergency rulemaking was adopted on March 9, 2016, and these rules became effective immediately. The emergency rules shall remain in effect for not longer than one hundred and twenty (120) days from the adoption date or until July 7, 2016, unless superseded by publication of a Notice of Final Rulemaking in the D.C. Register. 

 

The Director also gives notice of the intent to take final rulemaking action to adopt these proposed rules in not less than thirty (30) days after the date of publication of this notice in the D.C. Register.

 

Chapter 19, HOME AND COMMUNITY-BASED SERVICES WAIVER FOR INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES, of Title 29 DCMR, PUBLIC WELFARE, is amended as follows:

 

Subsection 1925.23 of Section 1925, INDIVIDUALIZED DAY SUPPORTS, is amended to read as follows:

 

1925.23           Individualized day supports shall be billed at the unit rate established for the staffing ratio noted in the service authorization.  The reimbursement rate for 1:1 staffing ratio shall be nine dollars and forty-three cents ($9.43) per billable unit or thirty-seven dollars and seventy-two cents per hour ($37.72). The reimbursement rate for 1:2 staffing ratio shall be five dollars and thirty-three cents ($5.33) per billable unit or twenty-one dollars and thirty-two cents ($21.32) per hour.  For persons who live independently or with family and select to receive a meal, the rate is increased by seven dollars and thirty-two cents ($7.32) per day that the person receives a meal.  This service shall not exceed one thousand, five hundred and sixty (1,560) hours per year or six thousand two hundred and forty (6,240) units annually.  A standard unit of service is fifteen (15) minutes and the provider shall provide at least eight (8) continuous minutes of services to bill for one (1) unit of service.       

 

Comments on these emergency and proposed rules shall be submitted, in writing, to Claudia Schlosberg, J.D., Senior Deputy Director/State Medicaid Director, District of Columbia Department of Health Care Finance, 441 Fourth Street, N.W., Suite 900 South, Washington, D.C. 20001, by telephone on [phone], by email at [e-mail], or online at www.dcregs.dc.gov, within thirty (30) days after the date of publication of this notice in the D.C. Register.  Copies of these emergency and proposed rules may be obtained from the above address.