The purpose of this chapter is to establish principles of reimbursement for nursing facilities participating in the District of Columbia Medicaid program.
Medicaid reimbursement to nursing facilities for services provided beginning February 1, 2018 shall be on a prospective payment system consistent with the requirements set forth in this chapter.
In order to receive Medicaid reimbursement, each nursing facility shall enter into a provider agreement with the Department of Health Care Finance (DHCF) for the provision of nursing facility services and comply with the screening and enrollment requirements set forth in Chapter 94 (Medicaid Provider and Supplier Screening, Enrollment, and Termination) of Title 29 of the District of Columbia Municipal Regulations (DCMR).
As a condition of Medicaid reimbursement, each nursing facility shall be licensed as a nursing home pursuant to the requirements set forth in the "Health Care and Community Residence License Act of 1983," effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code §§ 44-501 et seq. (2012 Repl.)) and meet the federal conditions of participation for nursing facilities in the Medicaid program as set forth in 42 CFR part 483.
Medicaid reimbursement for nursing facility services to a Medicaid beneficiary shall not be provided unless the Medicaid beneficiary has been determined clinically eligible for nursing facility services in accordance with 29 DCMR § 989 and District policy guidance.
D.C. Mun. Regs. tit. 29, r. 29-6500