D.C. Mun. Regs. tit. 22, r. 22-B3023

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 22-B3023 - REIMBURSEMENT FOR SERVICES TO PERSONS ELIGIBLE FOR D.C. MEDICAL CHARITIES

3023.1

The D.C. Medical Charities rates of reimbursement shall be as follows:

(a) Except as provided below, one hundred and six dollars ($106.00) per day for inpatient hospital services, and seventeen dollars ($17.00) per day for outpatient / emergency room services;

(b) Twenty-eight dollars ($28.00) per day for newborn care in the regular nursery and the premature nursery or the nursery for the care of the sick newborn;

(c) One thousand, one hundred dollars ($1,100.00) per day for discharge diagnoses of trauma under ICD-9 Diagnosis Codes 800 - 959, including burns; and

(d) Not more than forty-five dollars ($45.00) per day for residential drug therapy for patients with tuberculosis.

3023.2

The reimbursement rate set forth in § 3023.1(d) shall apply to the following:

(a) Housing;

(b) Meals that are nutritionally appropriate for persons recovering from tuberculosis;

(c) Direct drug therapy supervision; and

(d) Case management services.

3023.3

[Reserved]

3023.4

Reimbursement under the Medical Charities Program is available only for services provided to a person who meets the following eligibility requirements:

(a) The services to be provided are medically appropriate, as determined by the patient's attending physician;

(b) The person requesting services has an annual income that is equal to or less than one hundred and eighty-five percent (185%) of the current federal non-farm poverty level and provides documentation of such income;

(c) The person requesting services has no medical or health insurance to cover the procedure; and

(d) The person requesting services is a resident of the District of Columbia on the date on which services are sought and can so document, including providing:

(1) For a person more than twenty-one (21) years of age, at least two (2) of the following:

(A) A current bill addressed to the person at an address in the District;

(B) A voter registration card with an address in the District;

(C) A motor vehicle operator's permit issued by the District government;

(D) A motor vehicle registration certificate issued by the District government;

(E) A copy of a lease or agreement for real property located in the District;

(F) A cancelled check, money order receipt, or other receipt for payment of a mortgage, rent, or real property taxes for real property located in the District;

(G) A certified deed for real property located in the District;

(H) A payment receipt for a utility bill for real property located in the District;

(I) A withholding statement or tax statement for individual income taxes, including, a copy of a District tax return certified by the District Department of Finance and Revenue or a copy of a federal income tax return filed with the United States Internal Revenue Service for the tax year that immediately precedes the date on which services are sought;

(J) A non-driver identification card issued by the District government; or

(K) A Medicaid enrollment card or number; or

(2) For a person less than twenty-one (21) years of age, at least two (2) of the following:

(A) A motor vehicle operator's permit issued by the District government;

(B) A non-driver identification card issued by the District government;

(C) An original, notarized statement by an adult person over twenty-one (21) years of age, which attests that the adult has personal knowledge that the person under the age of twenty-one (21) is a resident of the District;

(D) A school identification card from a District school; or

(E) A Medicaid enrollment card or number.

3023.5

Services under this program are available on a first-come first-serve basis. The availability of this service shall not be deemed to create or constitute an entitlement or right to payment for services by the District of Columbia government.

3023.6

Reimbursement shall be paid only to a health care provider that:

(a) Has a current provider agreement with the Department of Human Services to provide services to persons who are eligible for assistance through the D.C. Medical Charities Program;

(b) Ensures that each person requesting services consents to the services in writing; and

(c) Is certified by the Commission of Public Health as qualified to provide any residential drug therapy for patients with tuberculosis.

3023.7

Initial and continued funding for financial assistance under this program shall be subject to the annual appropriations for the Medical Charities Program.

D.C. Mun. Regs. tit. 22, r. 22-B3023

Final Rulemaking published at 33 DCR 7388 (November 28, 1986); as amended by Final Rulemaking published at 37 DCR 5896 (September 7, 1990); and by Final Rulemaking published at 41 DCR 7675 (November 25, 1994); and by Final Rulemaking published at 46 DCR 7290 (September 17, 1999)

AUTHORITY: The authority for this section is D.C. Code, 2001 Ed. § 44 -706; Mayor's Order 86-37 (March 3, 1986); and Mayor's Order 99-73 (May 4, 1999).