D.C. Mun. Regs. tit. 29, r. 29-1902

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

Rule 29-1902 - ELIGIBILITY REQUIREMENTS

1902.1

Any person who currently receives services from DDS/DDA and who meets the following requirements shall be eligible to receive Waiver services:

(a) Has a special income level up to three hundred percent (300%) of the SSI federal benefit, or is aged and disabled with income up to one hundred percent (100%) of the federal poverty level, or is medically needy as set forth in 42 C.F.R. §§ 435.320, 435.322, 435.324 and 435.330;

(b) Has a developmental disability or an intellectual disability as defined in Section 1999;

(c) Is eighteen (18) years of age or older;

(d) Is a resident of the District of Columbia as defined in D.C. Official Code §§ 7-1301.03(22);

(e) Has a Level of Care ("LOC") determination that the person requires services furnished in an Intermediate Care Facility for Individuals with Intellectual Disabilities ("ICF/IID") or is a person with related conditions pursuant to the criteria set forth in §§ 1902.4; and

(f) Meets all other eligibility criteria applicable to Medicaid recipients including citizenship and alienage requirements.

1902.2

Waiver services shall not be furnished to a person who is an inpatient of a hospital, ICF/IID, or nursing facility.

1902.3

Each person enrolled in the Waiver shall be re-certified annually as having met all of the eligibility requirements as set forth in §§ 1902.1 for continued participation in the Waiver.

1902.4

A person shall meet the LOC determination set forth in §§ 1902.1(e) if one (1) of the following criteria has been met, taking into consideration the standard error of measurement for the intelligence quotient ("IQ") test:

(a) The person's primary disability is an intellectual disability with an IQ of fifty-nine (59) of less; or

(b) The person's primary disability is an intellectual disability with an IQ of sixty (60) to seventy (70), and the person has at least one (1) of the following conditions:

(1) Mobility deficits;

(2) Sensory deficits;

(3) Chronic health needs;

(4) Behavioral challenges;

(5) Autism;

(6) Cerebral Palsy;

(7) Epilepsy; or

(8) Spina Bifida.

(c) The person's primary disability is an intellectual disability with an IQ of sixty (60) to seventy (70), or the person has a developmental disability, either of which results in substantial functional limitations in at least three (3) of the following major life activities:

(1) Self-care;

(2) Understanding and use of language;

(3) Functional academics;

(4) Social skills;

(5) Mobility;

(6) Self-direction;

(7) Capacity for independent living; or

(8) Health and safety.

(d) The person has an intellectual disability, has severe functional limitations in at least three (3) of the major life activities as set forth in §§ 1902.4(c)(1) through §§ 1902.4(c)(8), and has one (1) of the following diagnoses:

(1) Autism;

(2) Cerebral Palsy;

(3) Prader Willi; or

(4) Spina Bifida.

D.C. Mun. Regs. tit. 29, r. 29-1902

Final Rulemaking published at 51 DCR 10207 (November 5, 2004); as amended by Final Rulemaking published at 61 DCR 4406 (May 2, 2014); amended by Final Rulemaking published at 63 DCR 10445 (8/12/2016); amended by Final Rulemaking published at 71 DCR 10372 (8/16/2024)

Authority: 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 (2012 Repl. & 2013 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.)).