4966805 Health Care Finance, Department of - Notice of Final Rulemaking - Governing Lead Investigations for Medicaid Eligible Children Under the Age of Twenty-One

DEPARTMENT OF HEALTH CARE FINANCE

 

NOTICE OF FINAL RULEMAKING

 

The Director of the Department of Health Care Finance, 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. 744; 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.)), hereby gives notice of the adoption of a new Section 921 of Chapter 9 (Medicaid Program), Title 29 (Public Welfare), of the District of Columbia Municipal Regulations (DCMR), entitled “Lead Investigations for Medicaid-Eligible Children”.

 

These rules authorize Medicaid reimbursement to the D.C. Department of the Environment (DDOE) or its agents to conduct environmental investigations that determine the presence of lead in a child’s primary residence when a medical diagnosis indicates an elevated blood level. This service is covered under the Medicaid State Plan and will be provided pursuant to the Early and Periodic, Screening, Diagnostic and Treatment benefit.  This service also supports DDOE in its mission to reduce District children’s exposure to lead contamination.

  

A Notice of Proposed Rulemaking was published in the D.C. Register on April 25, 2014 at 61 DCR 004200. No comments were received and no substantive changes have been made. The Director adopted these rules on June 23, 2014 and they shall become effective on the date of publication of this notice in the D.C. Register.

 

Chapter 9 (Medicaid Program), Title 29 (Public Welfare), of the District of Columbia Municipal Regulations (DCMR), is amended by adding the following new Section 921 to read as follows:

 

921                 LEAD INVESTIGATIONS FOR MEDICAID-ELIGIBLE CHILDREN

                       UNDER THE AGE OF TWENTY-ONE

 

921.1               Medicaid reimbursement shall be available to the D.C. Department of the Environment (“DDOE”) or its agent(s) to conduct investigations that determine the source of lead contamination in the primary residence of Medicaid-eligible children under the age of twenty-one (21) who have been diagnosed with elevated blood lead levels.

 

921.2               Reimbursement for an environmental investigation to identify lead contamination shall be limited to reimbursement for one (1) investigation per home where a Medicaid-eligible child who has been diagnosed with an elevated blood level resides.

 

921.3               Reimbursement shall only be provided if the investigation was performed by a certified Lead Risk Assessor.

921.4               The cost of testing of environmental substances identified during the on-site investigation shall not be reimbursable under this section.

 

921.5               The reimbursement rate for an environmental investigation shall be $476.72 for one (1) visit which shall represent one (1) unit of service.

 

921.99             DEFINITIONS

 

                        For purposes of this section, the following terms shall have the meanings ascribed.

                       

Risk Assessor – An individual who has been trained by an accredited training program and certified to conduct risk assessments (D.C. Official Code § 8-231.01 et seq).