11106.1To be reimbursed by Medicaid, in-home supports are services that are only provided to people enrolled in the IFS Waiver program who have an assessed need for assistance:
(a) With acquisition, retention or improvement in skills related to activities of daily living, and(b) Necessary to enable the participant to reside successfully at home in their community and participate in community activities based upon what is important to and for the participant as documented in their Individual Support Plan (ISP) and reflected in the participant's Person-Centered Thinking and Discovery tools.11106.2Services may be provided as follows:
(a) To people in the home or community, with the place of residence as the primary setting. A participant may receive in-home supports services when his or her place of residence is their own home, a family home, a friend's home, or transitional housing;(b) Services may be provided in person, by phone or by any other technology device that supports the use of video-audio communication, such as Skype, FaceTime, etc., as approved by the participant and his or her support team and documented in the ISP. In-home supports services using technology to communicate with the participant shall not exceed twenty (20) percent of the total hours of in-home supports services that the participant receives each week; and(c) For people with higher intensity support needs, high acuity in-home supports services are available with the additional supports described in 29 DCMR Chapter 90 in § 9025.4.11106.3To be eligible for reimbursement, participant-directed in-home supports services shall be:
(a) Included in a participant's ISP and Plan of Care and related to the participant's ISP goals; and(b) Habilitative in nature.11106.4In-home supports eligible for reimbursement shall include the following:
(a) Training and support in activities of daily living and independent living skills;(b) Support to enhance opportunities for meaningful adult activities and skills acquisition that support community integration and a participant's independence, including management of financial and personal affairs and awareness of health and safety precaution;(c) Support to enhance opportunities for community exploration aimed at discovery of new and emerging interests and preferences, including activities aimed at supporting the participant to have one or more new relationships;(d) Support to build community membership;(e) Training on, and assistance in, the monitoring of health, nutrition, and physical wellness;(f) Implementation of a home therapy program under the direction of a licensed clinician;(g) Training and support to coordinate or manage tasks outlined in the Health Care Management Plan, if applicable;(h) Assistance in performing personal care, household, and homemaking tasks that are specific to the needs of the participant, except that this may not comprise the entirety of the service;(i) Assistance with developing the skills necessary to reduce or eliminate behavioral episodes by implementing a Behavioral Support Plan (BSP) or positive strategies;(j) Opportunities for the participant to seek employment and vocational supports to work in the community in a competitive and integrated setting;(k) Assistance with the acquisition of new skills or maintenance of existing skills based on individualized preferences and goals identified in the In-Home Supports Plan, ISP, and Plan of Care; and(l) Coordinating transportation to participate in community events consistent with this service.11106.5In-home supports services shall only be provided for up to eight (8) hours per day unless there is a temporary emergency. In the event of a temporary emergency, DDS may authorize up to sixteen (16) hours per day for up to one hundred and eighty (180) days, during the participant's ISP year.
11106.6In the event of a temporary emergency, a written justification for an increase in hours shall be submitted with the In-Home Supports Plan, ISP, and Plan of Care by the provider to DDS. The written justification shall include:
(a) An explanation of why no other resource is available;(b) A description of the temporary emergency;(c) An explanation of how the additional hours of in-home supports services will support the participant's habilitative needs;(d) A revised copy of the ISP and Plan of Care reflecting the increase in habilitative supports to be provided; and(e) The service authorization from the Medicaid Waiver Supervisor or other Department on Disability Services Administration designated staff.11106.7In-home supports services may be used on the same day, or in combination with Medicaid State Plan Personal Care Aide (PCA) services, ID/DD PCA services, and Companion services, provided the services are not rendered at the same time.
11106.8In-home supports services shall not be used to provide supports that are normally provided by medical professionals.
11106.9Reimbursement for in-home supports services shall not include:
(a) Room and board costs;(b) Routine care and general supervision normally provided by the family or unpaid individuals who provide supports, or for services furnished to a minor by the child's parent or stepparent or by a participant's spouse;(c) Services or costs for which payment is made by a source other than Medicaid;(d) Travel or training of travel skills to Supportive Employment, Day Habilitation, Individualized Day Supports, or Employment Readiness; and(e) Costs associated with the PDW engaging in community activities with the people they support.11106.10In-Home Supports services in the My Life, My Way program shall be designed to promote independence and ensure the health, welfare, and safety of the participant.
11106.11The participant or their authorized representative, as applicable, shall serve as a "common law employer" of the PDW providing services. In the role of "common law employer," the participant or authorized representative shall be responsible for recruiting, hiring, supervising, and discharging PDWs providing in-home supports services.
11106.12Supports shall be available to assist the participant/representative-employer with their own employer-related responsibilities as described in § 11106.11 through the VF/EA FMS-Support Broker entity.
11106.13All participant-directed in-home support services provided by a PDW shall be prior authorized by DDS or its agent in order to be reimbursed under the My Life, My Way program.
11106.14To be eligible for participant-directed in-home supports services, a participant shall be in receipt of a service authorization for companion services from DDS or its designated agent that specifies the amount, duration, and scope of services authorized to be provided to the participant, in accordance with Section 9025 of Chapter 90 of Title 29 DCMR.
11106.15The hourly wage paid to a PDW shall be no lower than the living wage in the District, set in accordance with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01 et seq.), and no higher, including employment taxes and insurance amounts, than the current rate paid for agency-based in-home supports.
11106.16Payment for participant-directed in-home supports services shall be provided in accordance with the participant's PDS budget, at an hourly wage set by the participant/representative-employer which falls within the wage range established by DHCF as set forth in § 11106.15.
11106.17All participant-directed in-home supports participants shall comply with all applicable federal and District electronic visit verification requirements.
D.C. Mun. Regs. tit. 29, r. 29-11106
Final Rulemaking published at 70 DCR 8909 (6/23/2023)