6105585 Health Care Finance, Department of - Notice of Final Rulemaking - Governing Individualized Day Supports to Participants enrolled in the Home and Community based Services Waiver for Individuals with Developmental and Intellectual Disabilities

DEPARTMENT OF HEALTH CARE FINANCE

NOTICE OF FINAL 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. 744; D.C. Official Code § 1-307.02 (2014 Repl. & 2016 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 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 final 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. An 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. & 2016 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. A Notice of Emergency and Proposed Rulemaking for 29 DCMR § 1925 (Individualized Day Supports) was published in the D.C. Register on March 18, 2016, at 63 DCR 004105. The emergency and proposed rulemaking amended the previously published final rulemaking by changing the reimbursement rates in Subsection 1925.23. The emergency rulemaking was adopted on March 9, 2016, became effective immediately, and remained in effect until July 7, 2016. DHCF received no comments to the emergency and proposed rulemaking and no changes have been made.

 

The Director adopted these rules as final on June 23, 2016, and they shall become effective on 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.