D.C. Mun. Regs. tit. 29, r. 4201

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

Rule 4201 - ELIGIBILITY

4201.1

Individuals shall be deemed eligible for the HCB Waiver prior to the receipt of the HCB services described in this chapter.

4201.2

To be eligible for the HCB Waiver services described in this chapter, beneficiaries shall:

(a) Require the level of care furnished in a nursing facility as determined by DHCF's Long Term Care Services and Supports Contractor via standardized assessment tools in accordance with Subsections 4201.4 and 4201.5;

(b) Agree to participate in the waiver program by signing Waiver Beneficiary Freedom of Choice forms to elect to receive services in home and community-based settings rather than institutional settings;

(c) Be aged sixty- five (65) or older, or be aged eighteen (18) and older with one (1) or more physical disabilities;

(d) Not be inpatients of a hospital, nursing facility or intermediate care facility in accordance with Subsection 4201.3;

(e) Be financially eligible for long term care services and supports in accordance with the requirements set forth in Chapter 98 (Financial Eligibility for Long Term Care Services and Supports) of Title 29 DCMR; and

(f) Reside in the District of Columbia in community settings such as natural homes or approved Community Residential Facilities or EPD Waiver assisted living facilities.

4201.3

For purposes of eligibility, an inpatient shall be defined as a beneficiary who is institutionalized for a period greater than one hundred and twenty (120) consecutive days.

4201.4

A Registered Nurse (RN) or Licensed Independent Clinical Social Worker (LICSW) hired by, or under contract with, DHCF or its designee shall conduct a face-to-face assessment to determine if a beneficiary or applicant meets a nursing facility level of care. The assessment shall utilize a standardized assessment tool which will also evaluate the individual's care and support needs across three (3) domains including:

(a) Functional - impairments including assistance with activities of daily living such as bathing, dressing, eating or feeding;

(b) Skilled Care - sensory impairments, other health diagnoses and the need for skilled nursing or other skilled care (e.g., wound care, infusions); and

(c) Cognitive/Behavioral - communications impairments including the ability to understand others, presence of behavioral symptoms such as hallucinations, or delusions.

4201.5

Completion of the assessment shall yield a final total score determined by adding up the individual scores from the three domains. To be eligible for EPD Waiver services a beneficiary or applicant must obtain a score of nine (9) or higher which equates to a nursing home level of care.

4201.6

Eligibility for all EPD Waiver services shall be recertified on an annual basis in accordance with any procedures established by DHCF in this chapter.

D.C. Mun. Regs. tit. 29, r. 4201

Final Rulemaking published at 64 DCR 6787 (7/21/2017); amended by Final Rulemaking published at 68 DCR 3783 (4/9/2021)