944.1The Medicaid Program shall reimburse for adult companion services for each participant with mental retardation in the Home and Community Based Services Waiver for Persons with Mental Retardation and Developmental Disabilities (Waiver) subject to the requirements set forth in this section.
944.2Adult companion services include non-medical care, supervision, socialization, and assistance services that enable a client to perform household activities and access community resources and services.
944.3Adult companion services eligible for reimbursement include the following services:
(a) Assistance in locating and using natural and informal supports;(b) Assistance accessing neighborhood and community resources;(c) On-site companionship to ensure health and safety;(d) Reinforcement and support for individual decision-making;(e) Assisting or supervising a client with activities including the following: (1) Meal preparation, laundry, and shopping, provided that these services are not provided as discrete services; and(2) Light housekeeping tasks that are incidental to the care and supervision of a client;(f) Assistance using public transportation, including accompanying the client to community activities; and(g) Transportation to participate in community activities necessary to carry out this service, provided that the transportation provider has a provider agreement to bill for transportation services pursuant to 29 DCMR § 943.944.4Adult companion services shall not be available to clients being served by a provider already responsible for the general care and supervision of the client. Adult companion services shall not be billed concurrently with personal care services, respite care services, chore services, homemaker services, attendant care services, residential habilitation services, or independent habilitation services.
944.5Adult companion services shall not exceed four hundred eighty (480) hours per year beginning on the date the service is authorized.
944.6Adult companion services shall be authorized by the client's interdisciplinary team and provided in accordance with each client's individual habilitation plan (IHP) or individual support plan (ISP).
944.7Each provider of adult companion services shall:
(a) Be a non-profit organization, home health agency, social service agency, or other business entity;(b) Have a current District of Columbia Medicaid Provider Agreement that authorizes the provider to bill for adult companion services under the Waiver;(c) Maintain a copy of the most recent IHP or ISP approved by the Department of Human Services, Mental Retardation and Developmental Disabilities Administration (MRDDA);(d) Ensure that all adult companion services staff are qualified and properly supervised;(e) Ensure that the service provided is consistent with the client's IHP or ISP;(f) Offer the Hepatitis B vaccination to each person providing services pursuant to these rules; and(g) Provide training in infection control procedures consistent with the requirements of the (Occupational Safety and Health Administration, U.S. Department of Labor) as set forth in 29 CFR 1910.1030.944.8Each person providing adult companion services shall meet all of the following requirements:
(a) Be at least eighteen (18) years of age;(b) Be acceptable to the client;(c) Demonstrate annually that he or she is free of communicable diseases as confirmed by an annual PPD Skin Test or documentation from a physician stating that the person is free of communicable diseases;(d) Be able to communicate with the client;(e) Be able to read and write the English language;(f) Complete required training;(g) Have the ability to provide adult companion services consistent with the client's IHP or ISP;(h) Comply with the requirements of the Health-Care Facility Unlicensed Personnel Criminal Background Check of 1998, effective April 20, 1999 (D.C. Law 12-238, D.C. Official Code § 44-551 et seq.); and(i) Have two (2) or more years of college education, or a high school diploma, or its equivalent, and five (5) years of experience working with persons with mental retardation and developmental disabilities.944.9The billable units of service shall be one (1) hour.
944.10The reimbursement rate shall be twelve dollars ($12.00) per hour.
DEFINITIONS
When used in this section, the following terms and phrases shall have the meanings ascribed:
Client - an individual with mental retardation who has been determined eligible to receive services under the Home and Community-Based Waiver for Persons with mental Retardation and Developmental Disabilities.
Communicable disease - that term as set forth in section 201 of Chapter 2 of Title 22, District of Columbia Municipal Regulations.
Individual Habilitation Plan or IHP - that plan as set forth in section 403 of the Mentally Retarded Citizens Constitutional Rights and Dignity Act of 1978, effective March 3, 1979 (D.C. Law 2-137; D.C. Official Code § 7-1304.03) .
Individual Support Plan or ISP - the successor plan to the individual habilitation plan (IHP) as defined in the court-approved Joy Evans Exit Plan.
Socialization - interaction in the community with non-handicapped peers and access to neighborhood and community resources that strengthen the development of natural and informal supports.
D.C. Mun. Regs. tit. 29, r. 29-944
Final Rulemaking published at 50 DCR 8188 (October 3, 2003)