D.C. Mun. Regs. tit. 29, r. 4232

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

Rule 4232 - PROGRAM SERVICES: RESPITE SERVICES

4232.1

Respite services are intended to relieve the beneficiary's primary caregiver to provide a range of activities associated with the PCA's role.

4232.2

Medicaid reimbursable respite services shall include:

(a) Basic personal care such as bathing, grooming, and assistance with toileting or bedpan use;

(b) Assistance with prescribed, self-administered medication;

(c) Meal preparation in accordance with dietary guidelines and other cultural/religious dietary restrictions, and assistance with eating;

(d) Household tasks related to keeping the beneficiary's living areas in a condition that promotes the beneficiary's health, comfort, and safety; and

(e) Accompanying the beneficiary to medically related appointments.

4232.3

Medicaid reimbursable Respite services shall not include services that require the skills of a licensed professional, including, but not limited to, catheter insertion, procedures requiring sterile techniques, and medication administration.

4232.4

Medicaid reimbursable Respite services shall not include tasks usually performed by chore workers or homemakers, including cleaning of areas not occupied by the beneficiary; cleaning laundry for family members of the beneficiary; and shopping for items not used by the beneficiary.

4232.5

A unit of Medicaid reimbursable service for respite care shall be one (1) to twenty-four (24) hours spent performing allowable tasks.

4232.6

Medicaid reimbursable Respite services shall be limited to a maximum of four hundred and eighty (480) hours per year. Requirements for respite services in excess of the established limits shall be prior-authorized by the DHCF.

4232.7

Medicaid reimbursable Respite services shall not be billed in combination or at the same time as Personal Care Aide services.

4232.8

No waiver beneficiary shall receive Medicaid reimbursement for PCA services other than those provided by the in-home respite staff during the period of time which respite services are provided.

D.C. Mun. Regs. tit. 29, r. 4232

Final Rulemaking published at 64 DCR 6787 (7/21/2017)