D.C. Mun. Regs. tit. 29, r. 4250

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

Rule 4250 - PROGRAM SERVICES: PARTICIPANT-DIRECTED COMMUNITY SUPPORT SERVICES

4250.1

Medicaid will only reimburse PDCS services for EPD Waiver beneficiaries enrolled as participants in the Services My Way program.

4250.2

In order to receive Medicaid reimbursement, PDCS services shall be detailed in the participant's PCSP and PDS budget and shall be designed to promote independence and ensure the health, welfare, and safety of the participant.

4250.3

The participant or his or her authorized representative, as applicable, shall serve a "common law employer" of the PDW providing services. In the role of "common law employer," the participant or authorized representative shall be responsible for recruiting, hiring, supervising and discharging PDWs providing PDCS services.

4250.4

Supports shall be available to assist the participant or representative-employer with his or her own employer-related responsibilities as described in Subsection 4250.3 through the VF/EA FMS-Support Broker entity.

4250.5

PDCS services shall include cueing and assistance with activities of daily living and instrumental activities of daily living.

4250.6

All PDCS services provided by a PDW sha ll be prior authorized by DHCF or its agent in order to be reimbursed under the Services My Way program.

4250.7

To be eligible for PDCS services, a participant shall be in receipt of a service authorization for PCA from DHCF or its designated agent that specifies the amount, duration, and scope of services authorized to be provided to the beneficiary, in accordance with 29 DCMR § 5003.

4250.8

Payment for PDCS services shall be provided in accordance with the participant's PDS budget, at an hourly wage set by the participant or representative-employer which falls within the wage range established by DHCF as set forth in Subsection 4250.9.

4250.9

The hourly wage paid to a PDW shall be no lower than the living wage in the District, set in accordance with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01et seq.), and no higher than the wage paid by DHCF for services provided by a personal care aide in accordance with Chapter 42 of Title 29 DCMR.

4250.10

PDCS services shall not include the following:

(a) Services that require the skills of a licensed professional, as defined in the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01et seq.); or

(b) Tasks usually performed by chore workers or homemakers, such as cleaning of areas not occupied by the participant, laundry for family members, shopping for items not used by the participant, or money management.

4250.11

An age ncy-based provider of personal care aide services shall not be designated as an emergency back-up provider of PDCS services.

4250.12

In order to ensure PDCS services are provided in a manner that ensures the participant's health and safety, if a participant has been assessed for one hundred twelve (112) or more hours of PCA services per week in accordance with 29 DCMR § 5003, PDCS services must be provided by at least two (2) PDWs each week.

D.C. Mun. Regs. tit. 29, r. 4250

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