1901.1 Services available under the IDD Waiver shall include the following:

1. (a) Assistive Technology Services, 29 DCMR § 1941;
2. (b) Behavioral Support Services, 29 DCMR § 1919;
3. (c) Companion Services, 29 DCMR § 1939;
4. (d) Creative Arts Therapies Services, 29 DCMR § 1918;
5. (e) Day Habilitation Services, 29 DCMR § 1920;
6. (f) Dental Services, 29 DCMR § 1921;
7. (g) Employment Readiness Services, 29 DCMR § 1922;
8. (h) Family Training Services, 29 DCMR § 1924;
9. (i) Host Home without Transportation Services, 29 DCMR § 1915;
10. (j) Individualized Day Supports Services, 29 DCMR § 1925;
11. (k) In-Home Supports Services, 29 DCMR § 1916;
12. (l) Occupational Therapy Services, 29 DCMR § 1926;
13. (m) One-Time Transitional Services, 29 DCMR § 1913;
14. (n) Parenting Supports Services, 29 DCMR § 1942;
15. (o) Personal Care Services, 29 DCMR § 1910;
16. (p) Physical Therapy Services, 29 DCMR § 1928;
17. (q) Remote Supports Services, 29 DCMR § 1943;
18. (r) Residential Habilitation Services, 29 DCMR § 1929;
19. (s) Respite Services, 29 DCMR § 1930;
20. (t) Skilled Nursing Services, 29 DCMR § 1931;

(u) Speech, Hearing and Language Services, 29 DCMR § 1932;

(v) Supported Employment Services – Individual and Small Group Services, 29 DCMR § 1933;

(w) Supported Living Services, 29 DCMR § 1934; and

(x) Wellness Services, 29 DCMR § 1936.

1901.2 For dates of services beginning November 20, 2016, which aligns with Waiver Year 5, the Medicaid provider reimbursement rate(s) to be paid for the Waiver services identified in Subsection 1901.1 shall be posted on the District of Columbia Medicaid fee schedule at www.dc-medicaid.com. DHCF shall also publish a notice in the D.C. Register which reflects the change in the reimbursement rate(s) for Waiver services.

1901.3 No Waiver provider shall provide Waiver services unless in receipt of a Service Authorization from the Department on Disability Services, Developmental Disabilities Administration (DDS/DDA) for that Waiver service. A Service Authorization is an approval for a prescribed Waiver service issued by DDS/DDA to the provider prior to rendering service and is located on MCIS, DDS/DDA's case management information system, or its successor. DDS/DDA will not retroactively authorize services, except in the event of an emergency in which the provider has notified DDS and provided the services in good faith to avoid any service disruptions for the person, and subject to the approval of the Deputy Director for DDA.

1901.4 DHCF shall not reimburse any Waiver provider for services to the extent the provider:

1. (a) Fails to comply with any applicable regulation in this chapter;
2. (b) Fails to comply with all applicable federal and District of Columbia laws and regulations;
3. (c) Fails to comply with all applicable transmittals, rules, manuals and other requirements for payment issued by DHCF;
4. (d) Provides services in the absence of an approved prior authorization from DHCF or its designee for payment identifying the authorized service, number of hours or units authorized, duration, and scope of service; and
5. (e) Fails to comply with the terms of the Medicaid Provider Agreement.

1901.5 Each Waiver provider shall agree to accept, as payment in full, the amount determined by DHCF as reimbursement for the authorized Waiver services provided to beneficiaries.

1901.6 Each Waiver provider shall agree to bill any and all known third-party payers prior to billing Medicaid.

1901.7 A standard unit of fifteen (15) minutes requires a minimum of eight (8) minutes of continuous service to be billed.

SOURCE: Final Rulemaking published at 55 DCR 2896 (March 21, 2008); as amended by Final Rulemaking published at 61 DCR 2464 (March 21, 2014); as amended by Final Rulemaking published at 63 DCR 43 (January 1, 2016); as amended by Final Rulemaking published at 63 DR 10445 (August 12, 2016); as amended by Final Rulemaking published at 65 DCR 2190 (March 2, 2018); as amended by Final Rulemaking published at 71 DCR 010372 (August 16, 2024).