9017.1The purpose of this section is to establish standards governing the eligibility for Medicaid reimbursement of companion services for people enrolled in the Home and Community-Based Services Waiver for Individual and Family Support (IFS Waiver) and to establish the conditions of participation for providers of companion services.
9017.2Companion services provide non-medical assistance and supervision to support a person's goals, desires, and needs as identified in the person's Individual Support Plan (ISP), and reflected in his or her Person-Centered Thinking and Discovery tools. Goals may be related to the person's safety, promotion of independence, community integration, and/or retirement.
9017.3To be eligible for Medicaid reimbursement of companion services, the services shall be identified in the person's ISP, Plan of Care and Summary of Supports for each person enrolled in the Waiver, and each person shall:
(a) Demonstrate a need for non-medical support and supervision at home or in the community; and(b) Have the service recommended by the person's support team, after having considered the appropriateness of other waiver services and the staffing ratio, if any, in the person's home.9017.4Companion services may be provided in a person's home or in the community.
9017.5To be eligible for Medicaid reimbursement, companion services cannot be provided at the same time as In-Home Supports, Personal Care Services, Respite, and/or Behavioral Supports Non-Professional.
9017.6To be eligible for Medicaid reimbursement, companion services may be provided outside of regular Monday to Friday daytime hours when supervision or other non-medical support is necessary to protect the person from danger.
9017.7To be eligible for Medicaid reimbursement, companion services shall not:
(a) Exceed eight (8) hours per twenty-four (24) hour day;(b) Exceed forty (40) hours per week when used in combination with Personal Care Services or any other Waiver day or vocational support services, including but not limited to Day Habilitation, Employment Readiness, Supported Employment, Small Group Supported Employment, or Individualized Day Supports as part of a person's traditional Monday to Friday day/vocational programming time;(c) Include the provider/employee's transportation time to or from the person's home, or the provider employee's break time; and(d) Be provided to a person who requires a 24-hour medical one-to-one for supervision at home or in the community.9017.8In order to be reimbursed by Medicaid, companion services may be provided in a residential setting at the same ratio as is required of a DSP for that setting.
9017.9In order to be reimbursed by Medicaid, each provider of companion services shall:
(a) Be a Waiver provider agency;(b) Be certified by the DDS as a Companion Provider Agency per the DDS Provider Certification Review (PCR) Policy;(c) Provide verification of passing the DDS PCR for in-home support, supported living, or respite services for the last three (3) years. For providers with less than three (3) years of PCR certification, provide verification of a minimum of three (3) years of experience providing residential or respite services to the IFS waiver population, evidence of certification or licensure from the jurisdiction in which the service was delivered, and evidence of PCR certification for each year that the provider was enrolled as a waiver provider in the District of Columbia if applicable; and(d) Comply with Sections 9010 (Provider Qualifications) and 9009 (Provider Enrollment Process) of Chapter 90 of Title 29 DCMR.9017.10To be eligible for Medicaid reimbursement, the provider shall:
(a) Use the DDS-approved Person-Centered Thinking and Discovery tools to develop a support plan, based upon what has been identified as important to and for the person. For people who receive companion services during waking hours, this should include a flexible list of proposed leisure and recreational activities at home and in the community, based upon the person's interests. The support plan must be completed within first week of service, and reviewed and revised quarterly, or more frequently, as needed; and(b) Participate in the person's support team meeting, at the person's preference.9017.11In order to be eligible for Medicaid reimbursement each provider/ employee rendering companion services shall:
(a) Be at least eighteen (18) years of age;(b) Be acceptable to the person for whom they are providing supports;(c) Obtain annual documentation from a physician or other health professional that he or she is free from tuberculosis;(d) Complete competency-based training in:(1) Communication with people with intellectual disabilities;(2) Infection control procedures consistent with the requirement of the Occupational Safety and Health Administration, U.S. Department of Labor regulations at 29 C.F.R. § 1910.1030; and(3) Emergency procedures; and incident management;(e) Possess a high school diploma, GED certificate, or, if the person was educated in a foreign country, its equivalent;(f) Possess an active CPR and First Aid certificate and ensure that the CPR and First Aid certifications are renewed every two (2) years, with CPR certification and renewal via an in-person class;(g) Have the ability to communicate with the person to whom services are provided;(h) Be able to read, write, and speak the English language;(i) Participate in competency based training needed to address the unique support needs of the person, as detailed in his or her ISP; and(j) Have proof of compliance with the Health-Care Facility Unlicensed Personnel Criminal Background Check Act of 1998, effective April 20, 1999 (D.C. Law 12-238; D.C. Official Code §§ 44-551et seq.); as amended by the Health-Care Facility Unlicensed Personnel Criminal Background Check Amendment Act of 2002, effective April 13, 2002 (D.C. Law 14-98; D.C. Official Code §§ 44-551et seq.).9017.12An employee may not provide Medicaid reimbursable companion services to a person if he or she is the person's relative; legal guardian; or is otherwise legally responsible for the person.
9017.13Medicaid reimbursable companion services shall be authorized in accordance with the following provider requirements:
(a) The DDS shall provide a written service authorization before the commencement of services;(b) The service name and provider delivering services shall be identified in the ISP;(c) The ISP shall document the amount and frequency of services to be received; and(d) The provider shall submit each quarterly review to the person's DDS Service Coordinator no later than seven (7) business days after the end of the first quarter, and each subsequent quarter thereafter.9017.14In order to be eligible for Medicaid reimbursement each provider of companion services shall comply with Section 9006 (Records and Confidentiality of Information) of Chapter 90 of Title 29 DCMR, except that progress notes as described in § 9006.2(m) shall be kept on a daily basis.
9017.15In order to be eligible for Medicaid reimbursement each provider shall comply with the requirements under Section 9013 (Reporting Requirements) and Section 9005 (Individual Rights) of Chapter 90 of Title 29 DCMR.
9017.16Medicaid reimbursable companion services shall be billed at the unit rate. Companion services shall not exceed eight (8) hours per twenty-four (24) hour day. A standard unit of fifteen (15) minutes requires a minimum of eight (8) minutes of continuous service to be billed. Medicaid reimbursement shall be limited to those time periods in which the provider is rendering services directly to the person. There shall be a Medicaid reimbursement rate for:
(a) Companion services provided at a one-to-one ratio; and(b) Companion services provided in a small group of no more than one-to-three per person.D.C. Mun. Regs. tit. 29, r. 29-9017
Final Rulemaking published at 69 DCR 10229 (8/12/2022)