D.C. Mun. Regs. tit. 29, r. 29-9023

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

Rule 29-9023 - FAMILY TRAINING SERVICES

9023.1

This section shall establish conditions of participation for Medicaid providers enumerated in §§ 9023.9 ("Medicaid Providers") and family training services professionals and peer employees enumerated in §§ 9023.8 to provide family training services to caregivers of persons enrolled in the IFS Waiver.

9023.2

Medicaid reimbursable family training services are training, counseling, and other professional support services offered to uncompensated caregivers who provide support, training, companionship, or supervision to persons enrolled in the IFS Waiver, in accordance with the following:

(a) Family training services includes instruction about treatment regimens and other services included in the plan of care, use of equipment specified in the plan of care, and includes updates as necessary to safely maintain the individual at home;

(b) Counseling may be aimed at assisting the unpaid caregiver in meeting the needs of the individual;

(c) All training and counseling must be included in the individual's plan of care;

(d) Family training services are available as a one-to-one (1:1) service for a person, based upon the recommendation of the person's support team as reflected in the person's ISP;

(e) Family training services may be provided by professionals or peer employees who meet the qualifications at §§ 9011.3; and

(f) A person served through the IFS Waiver may utilize both one-to-one (1:1) family training services and services provided by professionals and qualified peer employees, subject to the limitations in §§ 9023.14.

9023.3

Uncompensated caregivers include any family member, neighbor, friend, companion, or co-worker who regularly provides uncompensated care to the person.

9023.4

In order to be eligible for reimbursement, each Medicaid provider must obtain prior authorization from the DDS prior to providing, or allowing any professional to provide, family training services. In its request for prior authorization, the Medicaid provider shall document the following:

(a) The person's need for additional, uncompensated support;

(b) The family training services professional who will provide the family training services; and

(c) The individual caregivers who will receive the family training services.

9023.5

In order to be eligible for Medicaid reimbursement, each family training services professional shall conduct an assessment of family training needs within the first four (4) hours of service delivery, and shall develop a training plan with training goals and techniques that will assist the unpaid caregivers of the person in the IFS Waiver. The training plan shall include measurable outcomes and a schedule of approved family training services to be provided, and shall be submitted by the Medicaid provider to DDS before services are delivered.

9023.6

In order to be eligible for Medicaid reimbursement, each Medicaid provider shall document the following in the person's ISP and Plan of Care:

(a) The date and amount of family training services provided;

(b) The nature of the family training services provided;

(c) The professional who provided the family training services; and

(d) The individual caregivers who received the family training services.

9023.7

Medicaid reimbursable family training services shall include the following activities:

(a) Instruction about treatment regimens and other services included in the person's ISP and Plan of Care;

(b) Instruction on the use of equipment specified in the person's ISP and Plan of Care;

(c) Counseling aimed at assisting the unpaid caregiver in meeting the needs of the person; and

(d) Follow up training necessary to safely maintain the person at home.

9023.8

Medicaid reimbursable family training services shall be provided by either professionals or peer employees as follows:

(a) Professionals shall be qualified as at least one (1) of the following:

(1) Special Education Teacher;

(2) Licensed Graduate Social Worker;

(3) Licensed Clinical Social Worker;

(4) Physical Therapist;

(5) Occupational Therapist;

(6) Registered Nurse; or

(7) Speech Pathologist.

(b) Peer employees shall meet the basic requirements set forth in 29 DCMR §§ 9011.3.

9023.9

In order to be eligible for Medicaid reimbursement, each family training services professional shall be employed by the following Medicaid providers:

(a) An IFS Waiver Provider enrolled by DDS; or

(b) A Home Health Agency as defined in Section 9099 of Chapter 90 of Title 29 of the DCMR.

9023.10

Each Medicaid provider shall comply with Section 9010 (Provider Qualifications) and Section 9009 (Provider Enrollment Process) of Chapter 90 of Title 29 of the DCMR.

9023.11

Each Medicaid provider shall maintain the following documents for monitoring and audit reviews:

(a) A copy of the most recent DDS approved ISP and Plan of Care, which shall include the documentation required by §§ 9023.6;

(b) The training plan developed in accordance with the requirements of §§ 9023.5; and

(c) The documents required to be maintained under Section 9006 (Records and Confidentiality of Information) of Chapter 90 of Title 29 of the DCMR.

9023.12

Each Medicaid provider shall comply with Section 9013 (Reporting Requirements) and Section 9005 (Individual Rights) of Chapter 90 of Title 29 of the DCMR.

9023.13

Medicaid reimbursable family training services shall not exceed a total of four (4) hours per day and one hundred (100) hours per year. Any hours in excess of these limits must be pre-approved by DDS pursuant to §§ 9023.14.

9023.14

In order to be eligible for Medicaid reimbursement, professionals requesting preapproval from DDS to provide family training services in excess of four (4) hours per day and one hundred (100) hours per year must demonstrate the need for such services. The decision of DDS to approve or disapprove the request for additional services, in whole or in part, shall be final.

9023.15

The billable unit of service for Medicaid reimbursable family training services shall be fifteen (15) minutes. A provider shall provide at least eight (8) minutes of service in a span of fifteen (15) continuous minutes in order to be able to bill a unit of service.

9023.16

Family training services may be delivered through remote supports to the extent the recommended service delivery is through remote supports services and the person is able to utilize equipment/technology needed for remote supports services as assessed and determined by the support team.

9023.17

Each provider of remote family training services shall comply with the requirements under Section 9036 (Remote Supports Services) of Chapter 90 of Title 29 DCMR.

9023.18

Remote family training services will be issued as a separate service authorization indicating the frequency of usage. A hybrid model may be used for in-person and remote supports services family training hours where two (2) service authorizations are issued to cover the in-person service hours and the remote supports services hours.

9023.19

Remote family training services reimbursement rates shall reflect the same rate as professional in-person family training reimbursement rates.

9023.20

Family training services provided by HCBS Waiver professionals through remote supports services must meet the criteria specified at §§ 9036.12.

D.C. Mun. Regs. tit. 29, r. 29-9023

Final Rulemaking published at 69 DCR 10229 (8/12/2022); amended by Final Rulemaking published at 71 DCR 10475 (8/23/2024)