6501 ELIGIBILITY FOR TRANSITION PLANNING SERVICE

6501.1 To be eligible for the Medicaid-funded transition planning service, individuals shall meet the following requirements:

(a) Be:

(1) A child or youth with mental health problems, as defined in D.C. Official Code § 7-1131.02(1F);

(2) An adult with mental illness as defined in D.C. Official Code § 7-1131.02(24); or

(3) An individual with a substance use disorder (SUD), as defined in Subsection 6301.1 of Chapter 63 of this subtitle;

(b) Be a bona fide resident of the District, as defined in D.C. Official Code § 7-1131.02(29);

(c) Be enrolled in Medicaid or be eligible for enrollment and in the process of applying;

(d) Be experiencing an institutional treatment stay described in § 6501.2; and

(e) Not be enrolled in any one of the following District programs:

(1) Medicaid managed care;

(2) Home and Community-Based Services Waiver for Persons who are Elderly and Individuals with Physical Disabilities, as described in Title 29 DCMR Chapter 42;

(3) Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities, as described in Title 29 DCMR Chapter 19;

(4) DC Health Home, as described in Title 22-A DCMR Chapter 25; or

(5) My Health GPS, as described in Title 29 DCMR Chapter 102.

6501.2 An individual meeting the criteria described in § 6501.1 shall be eligible for the transition planning service if they are experiencing an institutional stay in an inpatient hospital or residential SUD treatment setting related to a primary mental health or SUD diagnosis, and the service is rendered to the individual within thirty

(30) calendar days ahead of and/or on the day of discharge from the:

(a) Inpatient hospital setting into an outpatient or community-based setting, or SUD residential treatment setting; or

(b) SUD residential treatment setting into an outpatient or community-based setting, or a lower level SUD residential treatment setting.

SOURCE: Final Rulemaking published at 68 DCR 876 (January 15, 2021).