D.C. Mun. Regs. tit. 29, r. 29-7401

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

Rule 29-7401 - ELIGIBLE CONSUMERS

7401.1

To be determined eligible for HSS, an individual shall:

(a) Be eighteen (18) years of age or older;

(b) Be enrolled in Medicaid or meet the criteria described at §§ 7401.4;

(c) Be a resident of the District as defined in Section 2(32) of the Homeless Services Reform Act of 2005, as amended (D.C. Official Code §§4751.01(32));

(d) Have a documented disability or disabling condition;

(e) Be experiencing housing instability as evidenced by one of the following risk factors:

(1) Chronic homelessness;

(2) At risk of chronic homelessness; or

(3) History of chronic homelessness and for whom providing HSS will prevent a return to homelessness; and

(f) Be determined eligible for PSH services through the District's Coordinated Assessment Housing Placement system.

7401.2

An individual who is seventeen (17) years old or younger who lives in the household of an adult participating in the HSS benefit may qualify for PSH services.

7401.3

An HSS provider shall not receive Medicaid reimbursement under this Chapter for supportive services provided to an individual who does not meet the eligibility requirements set forth in subsection 7401.1.

7401.4

For individuals seeking enrollment in the District's Medicaid program or whose Medicaid coverage has lapsed:

(a) There is an eligibility grace period of ninety (90) calendar days from the date of first service for new enrollees, or from the date of eligibility expiration for enrollees who have a lapse in Medicaid coverage, until the date an eligibility or renewal determination is made;

(b) If the individual appeals a denial of Medicaid eligibility or renewal, the Director of the Department (Director) may extend the ninety (90) calendar day eligibility grace period until the appeal has been exhausted. The ninety (90) calendar day eligibility grace period may also be extended at the discretion of the Director for other good cause shown;

(c) Upon expiration of the eligibility grace period, HSS provided to the individual are no longer reimbursable by Medicaid; and

(d) Nothing in this section alters the District's timely filing requirements for claim submissions described at 29 DCMR §§ 900.

D.C. Mun. Regs. tit. 29, r. 29-7401

Final Rulemaking published at 71 DCR 6868 (6/7/2024)