D.C. Mun. Regs. tit. 29, r. 29-10104

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

Rule 29-10104 - INDIVIDUAL-DIRECTED GOODS AND SERVICES: SERVICE DESCRIPTION

10104.1

Individual-directed goods and services are only available to EPD Waiver beneficiaries who are enrolled as participants in the Services My Way program, and if they are purchased from the participant's PDS budget.

10104.2

Individual-directed goods and services are services, equipment or supplies not otherwise provided through the EPD Waiver or the Medicaid State Plan that address an identified need in the participant's PCP, including improving and maintaining the participant's opportunities for full membership in the community. Individual-directed goods and services shall meet the following requirements:

(a) The requested item or service decreases the participant's need for other Medicaid services;

(b) The requested item or service promotes the participant's inclusion in the community; or

(c) The requested item or service increases the participant's safety in the home environment.

10104.3

Allowable goods and services shall include, but are not limited to, the following:

(a) Small electric appliances which allow the participant to safely prepare meals; and

(b) Maintenance of items that meet the criteria of allowable individual-directed goods described in § 10104.2.

10104.4

Non-allowable goods and services shall include the following:

(a) Gifts for PDWs, family or friends, including bonus payments to PDWs;

(b) Loans to PDWs, family or friends;

(c) Food, beverages and nutritional supplements;

(d) Entertainment equipment or supplies such as televisions, stereos, CDs, DVDs, or streaming devices;

(e) Air conditioners, heaters, fans and similar items;

(f) Electronic devices that do not meet the requirements of § 10104.2 and do not meet an objective outlined in the participant's PCSP or that are not for the sole use of the participant;

(g) Illegal drugs;

(h) Alcoholic beverages or tobacco products;

(i) Costs associated with advertising for prospective PDWs;

(j) Costs associated with travel (airfare, lodging, meals, etc.);

(k) Utility, rent or mortgage payments;

(l) Clothing or shoes;

(m) Comforters, towels, linens or drapes;

(n) Paint or related supplies;

(o) Furniture or other household furnishings;

(p) Cleaning or laundry;

(q) Large household or kitchen appliances such as washers, dryers, dishwashers, refrigerators, or freezers;

(r) Exercise equipment;

(s) Medications, vitamins or herbal supplements;

(t) Experimental or prohibited treatments;

(u) Laundry detergent and household cleaning supplies;

(v) Vehicle expenses, including routine maintenance, repairs, parking or insurance costs;

(w) Transportation services that are otherwise available under Medicaid or the District's accessible transportation programs or through natural supports or that are not related to activities of daily living;

(x) Landscaping and yard work;

(y) Pet care and supplies, except when provided for service animals;

(z) Massages, manicures or pedicures;

(aa) Tuition for educational or recreational classes and other courses or training programs; and

(bb) Food preparation and delivery services including grocery delivery and delivery of prepared foods;

10104.5

Participants in the Services My Way program may purchase individual-directed goods and services that are included in their PCP, meet the requirements of §§ 10104.2 and 10104.3, and are within their PDS budget to purchase.

10104.6

Individual-directed goods and services shall be documented in the participant's PDS budget and PCP. The participant's support broker shall assist participants to revise their PDS budgets, as necessary, to account for new, appropriate individual-directed goods and services they would like to purchase. All revisions to a participant's PDS budget to account for new, appropriate individual-directed goods and services shall be accompanied by justification supporting the revision.

10104.7

Upon revising a PDS budget to reflect a new individual-directed good or service, the support broker shall submit the revised PDS budget to DHCF or its designee for approval.

10104.8

DHCF or its designee shall review all requested individual-directed goods and services.

10104.9

The VF/EA FMS-Support Broker entity shall only authorize payment of invoices submitted for individual-directed goods and services that are included in the participant's PCP and PDS budget and that have been approved by DHCF or its designee.

D.C. Mun. Regs. tit. 29, r. 29-10104

Final Rulemaking published at 64 DCR 9568 (9/29/2017); amended by Final Rulemaking published at 69 DCR 12090 (10/7/2022)