1913.1 This section establishes the conditions of participation for Medicaid providers enumerated in § 1913.6 (“Medicaid Providers”) to provide one-time transitional (OTT) services to persons enrolled in the Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (ID/DD Waiver).

1913.2 OTT services are one-time, non-recurring start-up expenses for persons enrolled in the ID/DD Waiver who are transitioning from an institution or provider-operated living arrangement to a living arrangement in a private residence where the person is directly responsible for their own living expenses.

1913.3 In order to be eligible for reimbursement, each Medicaid provider shall obtain prior authorization from the Department on Disability Services (DDS) prior to providing OTT services. The request for prior authorization shall include a written justification that demonstrates how the services will aid the person in transitioning to their own living arrangements and that the person is unable to pay for the expenses or that the service cannot be obtained from other sources.

1913.4 In order to be eligible for Medicaid reimbursement, each Medicaid provider shall document the following in the person’s Individual Support Plan (ISP) and Plan of Care:

1. (a) The date when OTT funds were provided; and
2. (b) A description and amount of each expense as described in § 1913.5.

1913.5 Medicaid reimbursable OTT services may include the following:

1. (a) Security deposits that are required to obtain a lease for an apartment or home;
2. (b) Essential household furnishings and expenses required to occupy or maintain an apartment or home;
3. (c) Start-up fees or deposits for utility or service access, including telephone, gas, electricity, and water;
4. (d) Services necessary for the person’s health, safety and wellbeing, such as pest eradication and one-time cleaning prior to occupancy;
5. (e) Home accessibility adaptations including carpeting, one-time general home repair, including roof repair, painting and fence repair; and
6. (f) Moving expenses related to transporting personal belongings.

1913.6 Medicaid reimbursable OTT services shall be provided by the following types of providers who possess a human care agreement with DDS:

1. (a) A provider of supported living services as described under Section 1934 of Chapter 19 of Title 29 of the DCMR; and
2. (b) A provider of residential habilitation services as described under Section 1929 of Chapter 19 of Title 29 of the DMCR.

1913.7 Each provider of Medicaid reimbursable OTT services shall comply with Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 of the DCMR.

1913.8 Each provider of Medicaid reimbursable OTT services shall maintain the following documents for monitoring and audit reviews:

1. (a) Copy of receipts documenting the date, item, amount expended, and any related warranty; and
2. (b) Any documents required to be maintained under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 of the DCMR.

1913.9 Each provider of Medicaid reimbursable OTT services shall comply with the requirements described under Section 1908 (Reporting Requirements) and Section 1911 (Individual Rights) of Chapter 19 of Title 29 DCMR.

1913.10 Medicaid reimbursement for OTT services shall not be available for:

1. (a) Monthly rental or mortgage expenses;
2. (b) Food;
3. (c) Regular utility charges;
4. (d) Household appliances or items that are intended for purely recreational purposes (e.g., television, cable or satellite installation for television programming, stereo or other audio equipment, or computerized gaming equipment);
5. (e) Environmental accessibility adaptation services that are of direct medical or remedial benefit to the person including specialized electric and plumbing systems necessary to accommodate medical equipment and supplies; and
6. (f) Any durable medical equipment.

1913.11 Medicaid reimbursement for OTT services shall be limited to a maximum of five thousand dollars ($5,000) per person for the duration of the ID/DD Waiver period as a one-time, non-recurring expense.

SOURCE: Final Rulemaking published at 55 DCR 2290 (March 7, 2008); as amended by Final Rulemaking published at 61 DCR 1647 (February 28, 2014).