11103.1 Qualified PDWs shall provide PDS as employees of My Life, My Way program participants.

11103.2 PDS may be provided by family members and individuals other than a participant's spouse, other legally responsible relative, or court-appointed guardian.

11103.3 Parents of adult children may provide PDS.

11103.4 Each family member providing PDS services shall comply with the requirements set forth in these rules.

11103.5 A legal guardian cannot be reimbursed through Medicaid for companion services provided to their ward.

11103.6 To be eligible for Medicaid reimbursement, the PDW in collaboration with the participant shall:

(a) Use the DDS-approved Person-Centered Thinking and Discovery tools to develop a program plan, based upon what has been identified as important to and for the participant as follows:

(1) The program plan shall be consistent with the outcome of PDS as documented in the ISP;

(2) 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 participant's interests;

(3) The program plan must be completed within the first week of service, and reviewed and revised quarterly, or more frequently, as needed; and

(b) Participate in the participant's support team meeting, at the participant's preference.

11103.7 All PDWs shall meet the following qualifications:

(a) Be at least eighteen (18) years of age;

(b) Complete and pass a criminal background check in accordance with the

Health-Care Facility Unlicensed Personnel Criminal Background Check Act of 1998, effective April 13, 2002 (D.C. Law 14-98; D.C. Official Code §§ 44-551 et seq.);

1. (c) Be legally authorized to work in the United States;
2. (d) Receive customized training provided by the participant and/or the participant's authorized representative that is related to the participant's functional needs and goals as outlined in the ISP;
3. (e) Be able and willing to perform the service-related responsibilities outlined in the participant's ISP;
4. (f) Provide documentation that each employee was found acceptable by the individual;
5. (g) Provide a Record of completion of competency-based training in emergency procedures;
6. (h) Attend a Training needed to address the unique support needs of the individual as detailed in their Plan of Care;
7. (i) 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;
8. (j) Have an individual National Provider Identifier (NPI) number obtained from the National Plan and Provider Enumeration System (NPPES);
9. (k) Obtain annual documentation from a physician or other health professional that he or she is free from tuberculosis; and
10. (l) Provide proof of COVID vaccination consistent with DC Health requirements.

11103.8 The VF/EA FMS-Support Broker entity shall be responsible for verifying that criminal background checks are conducted for all prospective PDWs in accordance with § 11103.7(b), and providing participants, authorized representatives, prospective PDWs, and DDS with the results of all criminal background checks performed on prospective PDWs.

11103.9 The participant or the participant's authorized representative, if designated as the 'common law employer' of the PDW, shall verify that a prospective PDW meets all qualifications set forth in § 11103.7 prior to hiring the PDW to provide PDS.

11103.10 The VF/EA FMS-Support Broker entity shall verify that a PDW meets all qualifications set forth in § 11103.7 prior to enrolling the PDW into its payroll system.

11103.11 The VF/EA FMS-Support Broker entity shall execute a District of Columbia Medicaid provider agreement with each PDW at the time a PDW is enrolled into its payroll system.

11103.12 Medicaid 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) Companion services shall be identified in the ISP; and

(c) The ISP shall document the amount and frequency of services to be received.

SOURCE: Final Rulemaking published at 70 DCR 008909 (June 23, 2023).