D.C. Mun. Regs. tit. 29, r. 29-9014
The DDS, through DDA, may establish a waiting list for individuals who are otherwise eligible for and requesting services and supports through enrollment in the IFS waiver, consistent with the approved IFS waiver, and in accordance with the requirements of the Department on Disability Services Establishment Act (D.C. Law 16-264; D.C. Official Code §§ 7-761.05(7)), and as further amended.
An individual is considered "eligible" if they meet the requirements for DDA services as set forth in D.C. Official Code §§ 7-1301.01et seq., and as amended by the Developmental Disability Eligibility Reform Amendment Act of 2022, effective May 18, 2022 (D.C. Law 24-117; D.C. Official Code §§ 7-761.02et seq.), and the eligibility criteria for participation in the IFS waiver program, which are found in the approved IFS waiver application, and are linked to the ICF/IID level of care criteria, and are set forth in 29 DCMR §§ 9002.1 to 9002.4.
All eligible individuals requesting supports, services, and IFS waiver enrollment shall be treated in a manner that is consistent with the terms of the IFS waiver, in accordance with the order of priority specified below.
An eligible individual seeking HCBS supports and services may do so through application to the IFS waiver program. The IFS waiver program is approved by the federal Centers for Medicare and Medicaid Services (CMS) to serve up to a set number of participants each year based on the approved IFS waiver application, as may be amended. If IFS waiver openings are not available because the maximum number of participants is being served, taking into account reserved capacity, DDA will establish a waiting list for deferred IFS waiver enrollment.
Consistent with CMS requirements and based on the availability of appropriated funds for these services, DDA will make every reasonable effort to ensure that eligible individuals on the waiting list will be enrolled and begin to receive IFS waiver supports and services as quickly as feasible given the availability of waiver slots and the order of priority established by the terms of the waiver and these rules.
The application of each eligible individual who applies for IFS waiver supports and services will be reviewed by DDA using the DDA Level of Need Assessment and Screening Tool (LON), or its successor.
Individuals on the waiting list for the IFS waiver will be enrolled and begin to receive IFS waiver services in the following priority order, based upon the results of the LON assessment, or its successor:
An individual is considered to have a "priority need" for enrollment in the IFS waiver if:
An individual is considered to have an "emergency need" for enrollment in the IFS waiver if the health and safety of the individual or others is in imminent danger and the situation cannot be resolved absent the provision of such services available from the IFS waiver program. Criteria for determining an emergency need include, but are not limited to:
An individual is considered to have an "urgent need" for enrollment in the IFS waiver if he or she is at significant risk of having his or her basic needs go unmet. Basic needs include the need for shelter, to eat, maintain one's health and to be free from harm, injury or threats to one's person or property.
An individual is considered to have a "non-urgent need" for enrollment in the IFS waiver if he or she:
For individuals with the same priority status, when there are openings available in the IFS waiver, DDA shall review all candidates and, based upon their needs as determined by the LON, shall make a determination of order of placement. Length of time on the waiting list shall be a factor considered, but is not solely considered to determine order of placement.
Based on funding availability, DDA will provide immediate non-waiver services to individuals on the waiting list who have been identified as having a priority or emergency need:
The application of each individual on the waiting list will be reviewed by DDA at least quarterly to determine any change in the support needs of the individual, the individual's family, and other relevant circumstances affecting the support needs of the individual. A review of a change in priority status will also be initiated within five (5) business days of the request by the individual, or any member of his or her support team.
Once a individual's application has been approved for IFS waiver enrollment, the individual will be assigned a service coordinator, who shall assist the individual with completing his/her IFS waiver application and with development of their ISP and IFS waiver Plan of Care.
If the individual is seeking out of home residential services through enrollment in the IFS waiver program, the individual must be Medicaid-eligible and the individual and his or her caregiver must be willing to accept available residential opportunities if necessary that meet the individual's primary needs at the time of assessment.
DDA will refer and assist individuals on the waiting list to identify, apply for and, when appropriate, obtain services from other District of Columbia or community based agencies for which they might be eligible, including services through the Medicaid State Plan.
An individual may be removed from the waiting list for IFS waiver service for any of the following reasons:
Each individual on the waiting list and his or her legal representative shall be provided sufficient information and opportunity to request an agency review of any DDA decision with which they disagree relating to the individual's placement on the waiting list, priority status or removal from the waiting list for reasons other than enrollment and initiation of IFS waiver services.
The agency review contemplated by this provision is an informal process by which the individual and his or her legal representative may seek reconsideration of a DDA decision by the DDS Deputy Director for DDA, or his or her designee, and requires a written request for reconsideration setting forth the factual and legal basis for the disagreement relating to the individual's placement on the waiting list, determination of order of priority status, or removal from the waiting list. Request for agency review must be made within thirty (30) days plus five (5) for mailing from the date the written notice in §§ 9014.22 and 9014.23 was mailed, unless there is good cause for a late request.
Each individual placed on the waiting list or removed from the waiting list for reasons other than enrollment and initiation of IFS waiver services shall be entitled to a fair hearing at the Office of Administrative Hearings (OAH) in accordance with 42 CFR 43, D.C. Official Code §§ 4-210.01et seq., and 29 DCMR §§ 9006.1 to 9006.3. Each individual on the waiting list and their legal representative shall have thirty (30) calendar days from receipt of the written notice in §§ 9014.22 and 9014.23 to demand a fair hearing.
DDA shall provide to each individual on the waiting list and their legal representative timely and adequate written notice of the DDA decision to place the individual on the waiting list or to remove the individual from the waiting list (for reasons other than enrollment and initiation of IFS waiver services) as follows:
In addition to the written notice provided under §§ 9014.21, DDA shall send each individual on the waiting list and their legal representative written notice of the DDA's decision to continue the individual's placement on the waiting list beyond the first six (6) months, and twice annually thereafter.
DDS shall publish an annual report on the waiting list during the prior fiscal year, which shall include a demographic profile of individuals on the waiting list; aggregate information on the level of need and requested supports and services of individuals on the waiting list; information about the length of time individuals have been on the waiting list; provide projected annual costs to meet the aggregate needs of all individuals on the waiting list; and discuss methods to reduce the waiting list and maximum waiting period.
DEFINITIONS
Aged Out - the threshold age when people receiving services from certain agencies are no longer eligible for those services and may then become eligible for services and supports from DDA.
Waiting List - [Repealed]
ICF/IID Level of Care Criteria - [Repealed]
Reserved Capacity - the number of waiver slots set aside as a commitment to wards of the State who are transitioning from the Children and Family Services Agency (CFSA) to adult services in DDS/DDA that are placed in out-of-home services to assure a seamless transfer to adult services and for people currently enrolled in the IFS waiver who may need to transition to the IDD waiver due to an increased level of need and/or services exceeding the $75,000 cap in the IFS waiver.
D.C. Mun. Regs. tit. 29, r. 29-9014