D.C. Mun. Regs. tit. 29, r. 4239

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

Rule 4239 - SPECIFIC PROVIDER REQUIREMENTS: EAA

4239.1

In order to receive Medicaid reimbursement, the case manager shall ensure that a home adaptation assessment is conducted by a licensed physician, occupational therapist, or physical therapist per a physician's order, prior to ordering EAA service(s) included in the beneficiary's PCSP.

4239.2

In order to receive Medicaid reimbursement, the home adaptation assessment shall include, but not be limited to, the following:

(a) Consulting (phone or in-person) with the beneficiary seeking EAA services, the case manager, and support team;

(b) Conducting an on-site assessment to address the beneficiary's accessibility needs and what modifications will be needed to his or her residence; and

(c) Drafting an EAA written report which includes a summary of the on-site assessment and recommendations of the home modifications based upon the beneficiary's needs.

4239.3

No EAA services shall be approved or reimbursed by Medicaid for a beneficiary seeking EAA services who qualifies for the Handicap Accessibility Improvement Program (HAIP) administered by the District of Columbia Department of Housing and Community Development (DHCD). The only qualified applicant for the HAIP is a certified home owner. An applicant who is a renter does not need to apply for HAIP.

4239.4

The case manager shall assist all eligible and certified home owners to apply for the HAIP program. If a home owner is denied participation in the program, he or she must provide a copy of the denial letter to the case manager.

4239.5

In the case of rental property or leased property, no EAA services shall be approved or reimbursed by Medicaid unless:

(a) The current rental, lease agreement, or other residential agreement or contract governing the beneficiary's current residence is thoroughly examined by the Case Manager and DHCF or its designee to determine that the services are not the responsibility of the property owner or manager; and

(b) A signed release was obtained from the management of the property authorizing the EAA home modifications to be made.

4239.6

Prior to initiating EAA services, the case manager shall assist the beneficiary seeking the receipt of EAA services to obtain an evaluation or home inspection from a Certified Third Party Construction Inspector or a Licensed Contractor.

4239.7

The Certified Third Party Construction Inspector shall be certified under the District of Columbia Department of Consumer and Regulatory Affairs (DCRA), Third Party Inspector Program.

4239.8

The Licensed Contractor shall be licensed to do business in the District of Columbia by the DCRA, or shall be licensed to do business in the jurisdiction in which EAA services are to be provided.

4239.9

The evaluation or home inspection shall:

(a) Determine that the beneficiary's residence is structurally sound;

(b) Determine whether the residence can accommodate the recommended EAA services;

(c) Identify any construction stipulations; and

(d) Recommend how the EAA home modifications should be constructed.

4239.10

After receiving the evaluation by the Certified Third Party Construction Inspector, or the Licensed Contractor, the case manager shall assist the beneficiary seeking EAA services to secure three (3) bids from building contractors for cost comparison of EAA services.

4239.11

DHCF may review documentation for approval when three (3) bids cannot be obtained for cost comparison.

4239.12

Each bid submitted by the building contractor for consideration for the receipt of a contract for the delivery of EAA services shall meet the following:

(a) Accept the job specifications contained in the home inspection by the Certified Third Party Construction Inspector, or the Licensed Contractor, unless otherwise agreed to and determined by DHCF;

(b) Be responsible for the costs associated with bringing to completion the EAA modifications described in the home adaptation assessment, including but not limited to, the costs of all construction materials, labor, and any subsequent inspections should the work be found to be substandard.

4239.13

Each building contractor shall be licensed to conduct business in the District of Columbia by the District of Columbia DCRA, or licensed to do business in the jurisdiction where the EEA adaptation services are provided. Each building contractor shall ensure that all construction staff has the training and skill level required to make the allowable in- home modifications.

4239.14

Services shall only be authorized for Medicaid reimbursement in accordance with the following provider requirements:

(a) For home-owners, verification of the denial letter issued by the DHCD HAIP program;

(b) Identification in the PCSP of the EAA service providers (Certified Third Party Contractor/Licensed Contractor and building contractor);

(c) Receipt of a copy of the home inspection;

(d) Receipt of a copy of the three (3) bid s or bid submitted to the case manager for consideration of the contract to provide EAA services; and

(e) Verification that the EAA home modifications do not conflict with the service limitations outlined in Section 4240.

4239.15

EAA service providers shall be exempt from the annual tuberculosis (TB) testing requirements.

4239.16

The EAA providers shall maintain a copy of the beneficiary's home inspection, and a copy of the bids submitted, and related documentation, for a period not to exceed ten (10) years.

D.C. Mun. Regs. tit. 29, r. 4239

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