10105.1 Individual-directed goods and services shall be provided only to EPD Waiver beneficiaries enrolled as participants in the Services My Way program.

10105.2 All individuals and vendors providing individual-directed goods and services shall meet the following minimum qualifications:

1. (a) All individuals providing individual-directed goods and services shall be at least eighteen (18) years of age;
2. (b) All individuals and vendors providing individual-directed goods and services shall be able to demonstrate to the participant that:
3. (1) The individual/vendor has the capacity to perform the requested work;
4. (2) The individual/vendor has the ability to successfully communicate with the participant; and
5. (3) The individual/vendor has all the necessary professional and/or commercial licenses required by federal and District law.

10105.3 Individuals and vendors providing non-medical transportation as an individual-directed service shall meet the following additional qualifications:

1. (a) The individual/vendor shall have a valid driver's license; and
2. (b) The individual/vendor shall have the minimum amounts of property damage liability, third party personal liability, uninsured motorist bodily injury, and uninsured motorist property damage insurance coverage required by the District of Columbia for the type of vehicle used to provide the transportation, in accordance with the Compulsory/No-Fault Motor Vehicle Insurance Act, effective September 18, 1982 (D.C. Law 4-155; D.C. Official Code §§ 31-2401 et seq.).

10105.4 No individual or vendor shall provide any individual-directed good or service that is not:

1. (a) Documented in the participant's PCP and PDS budget; and
2. (b) Approved by DHCF or its designee.

10105.5 Individuals and vendors selected by a participant to provide individual-directed goods or services shall enter into a Medicaid provider agreement with DHCF prior to providing the goods or services, as applicable. The Medicaid provider agreement shall be executed by the VF/EA FMS-Support Broker entity or a contracted Dual Eligible Special Needs Plan on behalf of DHCF.

10105.6 The VF/EA FMS-Support Broker entity shall verify that an individual or vendor selected by the participant to provide individual-directed goods and services meets all applicable requirements set forth in §§ 10105.2 and 10105.3 at the time of enrollment into the VF/EA FMS-Support Broker entity’s provider payment system and thereafter, as necessary.

SOURCE: Final Rulemaking published at 64 DCR 9567 (September 29, 2017); as amended by Final Rulemaking published at 69 DCR 012090 (October 7, 2022).