D.C. Mun. Regs. tit. 29, r. 29-10112
Participant/representative-employers shall be required to comply with all program rules and terms of the Participant/Representative-Employer Agreement and the Participant/Representative-Employer Consent Form executed at the time of enrollment in the Services My Way program.
Non-compliance with program rules or the terms of the Participant/Representative-Employer Agreement or Participant/Representative-Employer Consent Form shall subject the participant to the Remediation, Training and Termination Protocol established by DHCF.
Non-compliance with the terms of the Participant/Representative-Employer Agreement may be identified by the VF/EA FMS-Support Broker entity, the participant's support broker, the participant's EPD Waiver case manager, or DHCF staff.
Except in the case of a credible allegation of fraud, theft, or any other criminal behavior, as described in § 10112.11, a participant/representative-employer shall be afforded two (2) episodes of non-compliance across all areas of employer-related responsibilities delineated in the Participant/Representative Employer Agreement during the first twelve (12) months of enrollment in the Services My Way program. The third episode of non-compliance in any area of employer-related responsibility occurring within the first twelve (12) months of program enrollment shall result in the participant's termination from the Services My Way program and a transition to agency-based personal care aide services.
After the first twelve (12) months of program enrollment, participant/representative-employers shall be afforded a total of two (2) episodes of non-compliance, across all areas of employer-related responsibility delineated in the Participant/Representative Employer Agreement, during each twelve (12) month period of their enrollment in the Services My Way program. The third episode of non-compliance in any area of employer-related responsibility within each twelve (12) month period of program enrollment shall result in the participant's termination from the Services My Way program and a transition to agency-based personal care aide services.
When a participant/representative-employer is found to be out of compliance with the Participant/Representative-Employer Agreement for the first time within a twelve (12) month period of enrollment, the following steps shall occur:
The participant's support broker shall be responsible for monitoring the participant's adherence to the CAP.
If the participant or authorized representative, as applicable, fails to implement all or a portion of the CAP, this failure shall be considered an episode of noncompliance with the terms of the Participant/Representative-Employer Agreement and shall be reported to DHCF or its designee.
If a participant/representative-employer is found to be out of compliance with the Participant/Representative-Employer Agreement a second time within a twelve (12) month period of enrollment, the following steps shall occur:
If a participant/representative-employer is found to be out of compliance with the Participant/Representative-Employer Agreement a third time within a twelve (12) month period of enrollment, the following steps shall occur:
In the case of a credible allegation of fraud, theft, or any other criminal behavior related to program administration committed by a Services My Way participant, the participant shall not be referred to the remediation, training and termination protocol, and shall not be afforded three (3) episodes of non-compliance. The participant may be terminated from the program upon completion of an investigation by the DHCF Division of Program Integrity substantiating the credible allegation of criminal behavior.
If the DHCF Division of Program Integrity receives a credible allegation of fraud, theft, or any other criminal behavior by a Services My Way participant, the Division shall complete an investigation of the allegation and issue a report detailing its findings.
A credible allegation of fraud, theft or other criminal behavior is an allegation that has been reviewed and verified by DHCF from a source including, but not limited to, the following:
If the report issued in accordance with § 10112.12 finds the allegation to be substantiated, DHCF shall convene an interdisciplinary termination committee to review the report and determine whether to terminate the participant from the Services My Way program based on the findings documented in the report.
If DHCF decides to terminate a participant from the Services My Way program based on the determination of the committee described in § 10112.14, DHCF or its designee shall issue a termination notice to the participant/representative-employer, the support broker, and the EPD waiver case manager, which shall:
If a participant files a request for hearing with the Office of Administrative Hearings within thirty (30) days of the date on the Services My Way program termination notice, the participant shall remain enrolled in the Services My Way program and continue to receive PDCS services and individual-directed goods and services included in the participant's approved PDS budget while the participant's appeal is pending.
EPD Waiver case managers shall be responsible for transitioning participants to agency-based personal care aide services following termination from the Services My Way program. EPD Waiver case managers shall ensure that there is no break in service provision during the transition period and shall coordinate the approval by DHCF or its designee of the request to initiate agency-based personal care aide services.
Nothing in this section shall be construed to limit the District's authority to investigate and prosecute a Services My Way program participant for criminal acts including but not limited to theft and fraud.
D.C. Mun. Regs. tit. 29, r. 29-10112