D.C. Mun. Regs. tit. 29, r. 4247

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

Rule 4247 - SPECIFIC PROVIDER REQUIREMENTS: INDIVIDUAL-DIRECTED GOODS AND SERVICES

4247.1

In order to receive Medicaid reimbursement, individual-directed goods and services shall only be provided to EPD Waiver beneficiaries enrolled as participants in the Services My Way program.

4247.2

In order to receive Medicaid reimbursement, all individuals and vendors providing individual-directed goods and services shall meet the following minimum qualifications:

(a) All individuals providing individual-directed goods and services shall be at least eighteen (18) years of age;

(b) All individuals and vendors providing individual-directed goods and services shall be able to demonstrate to the participant that:

(1) The individual or vendor has the capacity to perform the requested work;

(2) The individual or vendor has the ability to successfully communicate with the participant; and

(3) The individual or vendor has all the necessary professional and/or commercial licenses required by federal and District law.

4247.3

In order to receive Medicaid reimbursement individuals and vendors providing non- medical transportation as an individual-directed service shall meet the following additional qualifications:

(a) The individual or vendor shall have a valid driver's license; and

(b) The individual or vendor shall have the minimum amounts of property damage liability, third party personal liability, uninsured motorist bodily injury, and uninsured motorist property damage insurance coverage required by the District of Columbia for the type of vehicle used to provide the transportation, in accordance with the Compulsory/No-Fault Motor Vehicle Insurance Act, effective September 18, 1982 (D.C. Law 4-155; D.C. Official Code §§ 31-2401et seq.).

4247.4

No individual or vendor shall be reimbursed by Medicaid for any individual-directed good or service that is not:

(a) Documented in the participant's PCSP and participant-directed services (PDS) budget; and

(b) Approved by the Services My Way Program Coordinator.

4247.5

An individual or vendor selected by a participant to provide individual-directed goods or services on a recurrent basis may be required to enter into a Medicaid provider agreement with DHCF prior to providing the goods or services. The Medicaid provider agreement shall be executed by the Vendor Fiscal/Employer Agent (VF/EA) Financial Management Services (FMS)-Support Broker entity supporting the Services My Way program on behalf of DHCF.

4247.6

The VF/EA FMS-Support Broker entity shall verify that an individual or vendor selected by the participant to provide individual-directed goods and services meets all applicable requirements set forth in Subsections 4247.2 and 4247.3 at the time of enrollment into the VF/EA FMS-Support Broker entity's provider payment system and thereafter, as necessary.

D.C. Mun. Regs. tit. 29, r. 4247

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