D.C. Mun. Regs. tit. 29, r. 4223
Each individual providing case management services shall meet the following requirements:
Effective March 25, 2016, except as provided in Subsection 4223.3, an individual providing case management services, who is employed or under contract to a Home and Community-Based Services Waiver for Persons who are Elderly and Individuals with Physical Disabilities (EPD Waiver) case management service provider shall self-attest to meeting the CMS conflict- free standards in accordance with 42 CFR § 441.301(c)(1)(vi) using the DHCF Conflict-Free Case Management Self-Attestation Form. Under these standards, individual case managers shall not:
An individual providing EPD Waiver case management services shall meet the requirements of Subparagraph 4223.1(h)(2) no later than July 1, 2016.
EPD Waiver case management service providers shall ensure they have a copy of the DHCF Conflict-Free Case Management Self- Attestation Form on file for each case manager prior to submission of any claims for case management services provided by that case manager on or before July 1, 2016. DHCF Conflict-Free Case Management Self-Attestation Forms are subject to inspection and audit and must be produced upon request.
Individuals conducting case management services shall meet one of the following educational requirements:
Case management service providers shall not provide medical, financial, legal, or other services or advice for which they are not qualified or licensed to provide (except for providing referrals to qualified individuals, agencies, or programs).
Effective March 25, 2016, except as provided in Subsection 4223.8, in accordance with 42 CFR § 441.301(c)(1)(vi), the following providers shall not be eligible to provide case management services:
Effective March 25, 2016, an entity that is enrolled to provide case management services that is also a Medicaid provider of PCA services or any other direct services under the EPD Waiver; or has a financial relationship, as defined in 42 CFR § 411.354, with a Medicaid provider of PCA services or any other direct services under the EPD Waiver, shall have until July 1, 2016, to come into compliance with Subsection 4223.7.
An entity described in Subsection 4223.8 was required to notify DHCF of its election to continue or discontinue providing case management services no later than September 1, 2015. An entity that chose to discontinue case management services was required to submit a transition plan to DHCF no later than October 1 2015, and to cooperate with DHCF to effectuate the orderly and timely transition of its enrollees to other case management providers that meet the conflict- free case management standards. These transition plans were required to include sufficient safeguards to protect individuals who were at risk of experiencing gaps in services during transitions, including demonstrating efforts to ensure compliance with any notice or due process rights governed under local and federal law in case of service suspensions, or terminations.
Each case management service provider shall conduct an initial evaluation within forty-eight (48) business hours of receiving the waiver referral and prior to the development of the PCSP. All initial PCSPs and all renewal PCSPs were required to conform to the person-centered planning requirements in 42 CFR §§ 441.301(c)(1) - (3) by November 1, 2016, and case managers shall use DHCF's person-centered-planning template, available at http://dhcf.dc.gov/release/person-centered-planning, to develop each beneficiary's PCSP.
Each case management service provider shall complete and submit the PCSP to DHCF or its designee for review and approval within ten (10) business days of conducting the initial evaluation.
Each case management service provider shall include the person whose plan is being developed, other contributors chosen and invited by the person, and representatives of the person's interdisciplinary team, if possible, in the initial evaluation referenced in Subsection 4223.10 and in the development and implementation of the PCSP. The person or authorized representative shall have access to the PCSP and shall be involved in the periodic review of the PCSP.
It is the responsibility of the case management service provider to ensure that all other professional disciplines, as identified for resolution of identified needs, are incorporated into the PCSP. Specifically, each case management service provider shall coordinate a beneficiary's care by sharing information with all other health care and service providers identified in the PCSP, as applicable, to ensure that the beneficiary's care is organized and to achieve safer and more effective health outcomes.
Each case management service provider shall maintain, follow, and continually update a training and supervision program to ensure the individual delivering case management services is fully trained and familiar with the waiver policies and procedures, including CMS's conflict- free case management standards as set forth in this section.
Each provider of case management services shall ensure that individuals providing case management services are appropriately supervised and that the case management service provided is consistent with the person's PCSP.
D.C. Mun. Regs. tit. 29, r. 4223