1915 HOST HOME WITHOUT TRANSPORTATION SERVICES

1915.1 The purpose of this section is to establish standards governing Medicaid eligibility for host home without transportation services under the Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (ID/DD Waiver), and to establish conditions of participation for providers of host home services.

1915.2 Host home without transportation services enable a person to retain or improve skills related to: health; activities of daily living; money management; community mobility; recreation; cooking; shopping; use of community resources; community safety; and to develop other adaptive skills needed to live in the community, based upon what is important to and for the person as documented in his or her Individual Support Plan (ISP) and reflected in his or her Person-Centered Thinking and Discovery tools.

1915.3 To be eligible for Medicaid reimbursement of host home without transportation services, each person shall have limited informal supports, benefit from living in a family environment, and demonstrate a need for support for up to twenty-four (24) hours per day, and the services shall be:

(a) Provided in a private home, referred to as “host home,” which may be leased or owned by the principal care provider, who lives in the home; and

(b) Identified as a need in the person’s Individual Support Plan (ISP) and Plan of Care.

1915.4 The total number of persons living in the host home (including those served in the ID/DD Waiver) and who are unrelated to the principal care provider cannot exceed three (3).

1915.5 In order to be reimbursed by Medicaid, the ID/DD Waiver provider shall:

(a) Use the Department on Disability Services (DDS) approved Person-Centered Thinking tools and the person’s Positive Personal Profile and Job Search and Community Participation Plan to develop a functional assessment that includes what is important to and for the person, within the first month of the person residing in the host home. This assessment shall be reviewed and revised annually or more frequently as needed;

(b) Participate as a member of the person’s support team, and coordinate with the principal care provider to participate, including making recommendations for the development of the ISP and Plan of Care;

(c) Assist in the coordination of all services that the person may receive;

(d) Develop a program plan with measurable outcomes using the functional assessment from the DDS approved Person-Centered Thinking tools, Positive Personal Profile and Job Search and Community Participation Plan, the ISP, Plan of Care, and other information as appropriate to enable the person to safely reside in and be integrated as a member of his or her community; and

(e) Review the person's ISP and Plan of Care goals, DDS-approved Person-Centered Thinking tools, Positive Person Profile and Job Search and Community Participation Plan, objectives, and activities at least quarterly, and more often as necessary, and submit quarterly reports to the person, family and/or guardian, and DDS Service Coordinator in accordance with the requirements described, under Section 1908 (Reporting Requirements) and Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR.

1915.6

In order to be reimbursed by Medicaid, the ID/DD Waiver provider shall coordinate care with the principal care provider, Direct Support Professionals (DSP) working for the respite provider, and others as applicable, to ensure the person's needs are met in the following categories of support, unless the person has demonstrated independence and capacity in any of the areas. Supports provided shall be related to the person's ISP goals and habilitative in nature, aimed at teaching the person to increase his or her skills and self-reliance. These categories or areas of support shall include, but are not limited to, the following:

(a) Room and board (not included in the ID/DD Waiver reimbursement rate);

(b) Assistance with eating and food preparation, including learning about healthy eating choices;

(c) Assistance with personal hygiene;

(d) Assistance with dressing;

(e) Assistance with monitoring the person's health and physical condition;

(f) Assistance with the administration of medication;

(g) Assistance with communication between the person and other health care providers;

(h) Assistance with interpersonal and social skills;

(i) Assistance with household chores;

(j) Assistance with mobility;

(k) Assistance with motor and perceptual skills;

(l) Assistance with problem-solving and decision-making;

(m) Maintenance of medical records;

(n) Maintenance of financial records;

(o) Assistance with attending health care appointments, by the coordination of transportation to and from the person's appointments;

(p) Assistance with planning and attending events;

(q) Habilitative support in activities of daily living and/or therapeutic goals and objectives as described in the ISP and Plan of Care;

(r) Assistance with enhancing the person's opportunities for engagement in community life, including but not limited to social, recreational, and religious activities utilizing community resources;

(s) Assistance with ensuring that the person's adaptive equipment is appropriate and functioning;

(t) Provide assistance with finding opportunities for employment in the community in a competitive and integrated setting; and

(u) Other supports that are identified as important to or for the person as identified in his or her ISP.

1915.7 In order to be reimbursed by Medicaid, the ID/DD Waiver provider shall coordinate the delivery of professional services to each person residing in a host home that may include, but are not limited to, the following disciplines or services:

(a) Medical Care;

(b) Dentistry;

(c) Education;

(d) Nutrition;

(e) Nursing;

(f) Occupational therapy;

(g) Physical therapy;

(h) Behavioral support;

(i) Assistive Technology;

(j) Parenting Supports;

(k) Speech, hearing and language therapy; and

(l) Wellness.

1915.8 In order to be reimbursed by Medicaid, each ID/DD Waiver provider that oversees a person's host home placement shall:

(a) Receive and review packets submitted by DDS requesting development of a host home for a particular applicant;

(b) Respond to inquiries for host home development in a timely manner;

(c) Recruit a principal care provider to deliver host home services;

(d) Identify and develop on-going relationships with local medical professionals, including those in community health clinics (e.g., dentist, physician, psychiatrist, psychologist, occupational therapist, physical therapist, etc.);

(e) Coordinate and document a matching process that includes at a minimum two (2) visits, at least one (1) of which must be an overnight stay by the person at the prospective principal care provider's home. This should include exploration of the person's and principal care provider's culture, language, preferences and routines;

(f) Coordinate transportation with the DDS Service Coordinator for visits to the prospective host home of the principal care provider;

(g) Participate as a member of the person's support team, in accordance with

his or her preference, including making recommendations for the development of the person's ISP and Plan of Care;

(h) Arrange for essential supports, including training, supplies and equipment to be in place prior to the person's move into a host home setting;

(i) Arrange for non-essential, but recommended and necessary supports to be put into place subsequent to a person's move into a host home setting; and

(j) Provide information as needed to the person, the person's family or authorized representative, support team, DDS Service Coordinator, and the principal care provider.

1915.9 In order to be reimbursed by Medicaid, the ID/DD Waiver provider shall:

(a) Coordinate the use of transportation for each person residing in a host home to his or her day programs, places of employment, and/or community engagements as needed;

(b) Coordinate general support monitoring at least twice per month to review conditions in the host home, the person's health status, implementation of the ISP, update activity schedules, review medical and other appointments, and draft progress notes;

(c) Coordinate health care monitoring for each person residing in the host homes, including frequency of nursing visits, and document this in the person's Health Care Management Plan. This must include, at a minimum, monitoring by a registered nurse (RN) at least every ninety (90) days for persons with no prescribed medications, and at least monthly for persons on prescribed medications. Additionally, the ID/DD Waiver provider shall ensure that the RN completes progress notes during each visit as well as quarterly reports, as appropriate;

(d) Provide respite to the principal care provider for up to a total of fourteen (14) days per year. If respite care and emergency support is provided in the host home, Medicaid reimbursement payments for host home without transportation services shall continue for fourteen (14) days. If respite is provided in another location, the host home services percentage of the reimbursement rate shall be paid to the ID/DD Waiver provider;

(e) Provide emergency support to the person enrolled in the ID/DD Waiver, in the event that an emergency renders a principal care provider unable to provide supports;

(f) Coordinate compliance with DDS policies and procedures;

(g) Provide training to ensure that the principal care provider is knowledgeable about DDS policies and procedures;

(h) Ensure that, for people who take prescribed medications and need assistance with administration, it is provided by a Trained Medication Employee, at a minimum; and

(i) Accompany the person to annual review court hearings and provide reports to be utilized during court hearings, where applicable.

1915.10 [RESERVED]

1915.11 In order to be reimbursed by Medicaid, the host home residence and the ID/DD Waiver provider shall meet the DDS Certification Standards as set forth in the Human Care Agreement between the principal care provider, the ID/DD Waiver provider, and DDS, if applicable.

1915.12 In order to be reimbursed by Medicaid, host home without transportation services shall be administered by supported living service providers or residential habilitation service providers, which in this section shall be referred to as the ID/DD Waiver provider.

1915.13 In order to be reimbursed by Medicaid, each ID/DD Waiver provider of host home services without transportation shall demonstrate verification of passing the DDS Provider Certification Review (PCR) for residential or respite services for at least three (3) years, unless waived by a designated DDA staff. Waiver providers with less than three (3) years of PCR certification shall provide verification of at minimum of three (3) years of experience providing residential or respite services to the ID/DD population, evidence of certification or licensure from the jurisdiction in which the service was delivered, and evidence of PCR certification for each year that the provider was enrolled as an ID/DD Waiver provider in the District of Columbia, if applicable.

1915.14 In order to be reimbursed by Medicaid, each ID/DD Waiver provider of host home without transportation services shall agree to the following:

(a) Participate on the person's support team, in accordance with his or her preference;

(b) Comply with Sections 1904 (Provider Qualifications) and 1905 (Provider Enrollment) of Chapter 19 of Title 29 DCMR; and

(c) Maintain a signed, current Human Care Agreement with DDS when deemed necessary by DDS.

1915.15 In order to be reimbursed by Medicaid, each host home residence and supporting ID/DD Waiver provider located out-of-state shall be licensed and/or certified in accordance with the host state's laws and regulations and/or consistent with the terms and conditions set forth in an agreement between the District of Columbia and the host state. Each out-of-state host home and ID/DD Waiver provider shall comply with the following additional requirements:

1. (a) Remain in good standing in the jurisdiction where the program is located;
2. (b) Submit a copy of the current license, annual certification or survey performed by the host state and provider's corrective action to DDS;
3. (c) Allow authorized agents of the District of Columbia government, federal government, and governmental officials of the host state full access to all sites and records for audits and other reviews; and
4. (d) Successfully meet the certification review requirements of DDS.

1915.16 Each principal care provider and direct support professional (DSP) providing host home without transportation services shall meet all of the requirements in Section 1906 (Requirements for direct support professionals) of Chapter 19 of Title 29 DC MR.

1915.17 In order to be reimbursed by Medicaid, each principal care provider shall agree to cooperate and attend mandatory training sessions provided by DDS and the ID/DD Waiver provider regarding abuse and neglect, incident reporting, and training on the unique needs of the person, and to allow DDS Service Coordinator and other DDS employees' reasonable access to the host home.

1915.18 In order to be reimbursed by Medicaid, host home without transportation services shall be authorized for reimbursement in accordance with the following provider requirements:

1. (a) DDS shall provide a written service authorization before the commencement of services;
2. (b) The ID/DD Waiver provider shall conduct an assessment and develop a host home assessment plan with training goals and techniques that will assist the principal care provider, within the first thirty (30) days of service delivery;
3. (c) The service name and the ID/DD Waiver provider delivering services shall be

identified in the ISP and Plan of Care;

(d) The ISP, Plan of Care, and Summary of Supports and Services shall document the amount and frequency of services to be received; and

(e) Services shall not conflict with the service limitations described under Subsection 1915.25.

1915.19 In order to be reimbursed by Medicaid, each ID/DD Waiver provider of host home without transportation services shall maintain the following documents for monitoring and audit reviews:

(a) Any documents required to be maintained under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 of the DCMR;

(b) A copy of the person’s most recent DDS approved ISP and Plan of Care;

(c) A current written staffing plan, if additional DSP support services in the home are needed;

(d) A written explanation of staffing responsibilities when the principal care provider is unavailable to provide support to the person enrolled in the ID/DD Waiver;

(e) Current financial records of expenditures of public and private funds for each person;

(f) The records of any nursing care provided pursuant to a physician ordered protocol and procedure, charting, and other supports provided in accordance with a physician’s order relating to the development and management of the Health Care Management Plan; and

(g) Progress notes written by the principal care provider on a weekly basis and archived at the ID/DD Waiver provider’s central office.

1915.20 In order to be reimbursed by Medicaid, each ID/DD Waiver provider of host home without transportation services shall comply with Sections 1908 (Reporting Requirements), 1911 (Individual Rights), and 1938 (Home and Community-Based Setting Requirements) of Chapter 19 of Title 29 DCMR. All Host Home settings must fully comply with the requirements of the HCBS Settings Rule.

1915.21 Host home without transportation services shall not be reimbursed by Medicaid if they are billed at the same time as the following ID/DD Waiver services are provided to the person:

(a) Supported Living;

(b) Residential Habilitation;

(c) Personal Care, unless provided when a person is working or in school;

(d) Respite; and

(e) In-Home Supports.

1915.22 In order to be eligible for Medicaid reimbursement, host home without transportation services shall not include a day when the person is hospitalized, on vacation, or other days during which the person is not residing at the host home, with the exception of days when the person is on vacation with the principal care provider or with other host home ID/DD Waiver provider supports.

1915.23 In order to be eligible for Medicaid reimbursement, host home without transportation services shall not include a day when the person is not residing at the host home, with the exception of days when the person is temporarily residing in a hotel or other facility due to an emergency situation.

1915.24 The following individuals shall not be authorized to enroll as an ID/DD Waiver provider of host home without transportation services for the person or as the principal care provider:

(a) The person's legal guardian;

(b) The person's parent;

(c) The person's spouse; or

(d) Any other legally responsible person.

1915.25 Reimbursement for host home without transportation services shall not include:

(a) Cost of room and board;

(b) Cost of facility maintenance, upkeep, and improvement;

(c) Activities for which payment is made by a source other than Medicaid; and

(d) Time when the person is in school or employed.

1915.26 The reimbursement rate for host home without transportation services is a daily inclusive rate based on the person's acuity level. The acuity level shall be determined by DDS based on the results of the Level of Need Assessment and Screening Tool, or its successor, or as documented in the person's ISP.

1915.27 The daily inclusive reimbursement rate for host home without transportation services shall be broken down by the person's acuity level into the basic support rate, the moderate support rate, and the intensive support rate. The host home without transportation services reimbursement rate shall include:

(a) Programmatic supplies;

(b) Oral/topical medication management;

(c) General and administrative costs for ID/DD Waiver services;

(d) Relief of the caregiver and emergency support;

(e) All direct support costs based on the needs of the person; and

(f) Additional supports provided by a DSP for up to twenty (20) hours per week.

1915.28 In the event that additional DSP supports are requested, the ID/DD Waiver provider shall submit to the DDS Service Coordinator, the following documents:

(a) A written justification; and

(b) A summary of the responsibilities of the DSP who is scheduled to provide the additional supports.

1915.29 Persons with extraordinary needs may be eligible to receive a specialized reimbursement rate not to exceed a maximum dollar amount per day, subject to DDS approval.

1915.30 Forty percent (40%) to sixty percent (60%) of the daily reimbursement rate shall be paid to the principal care provider by the ID/DD Waiver provider for support services. The remaining forty percent (40%) to sixty percent (60%) of the daily reimbursement rate shall be retained by the ID/DD Waiver provider for training, additional in-home support services based on the needs of the person, medication management, general and administrative costs for ID/DD Waiver services, general supervision, and relief and emergency coverage. The actual percentage of the daily reimbursement rate allocated between the principal care provider and the

ID/DD Waiver provider shall be negotiated between the parties based on the specific support needs of the person.

1915.31 The person receiving host home without transportation services shall contribute an amount based on his or her Social Security benefits to the principal care provider to pay towards his or her room and board expenses.

SOURCE: Final Rulemaking published at 55 DCR 9076 (August 22, 2008); as amended by Final Rulemaking published at 61 DCR 1941 (March 7, 2014); as amended by Final Rulemaking published at 62 DCR 4629 (April 10, 2015); as amended by Final Rulemaking published at 64 DCR 7469 (August 4, 2017); as amended by Final Rulemaking published at 65 DCR 2190 (March 2, 2018); as amended by Final Rulemaking published at 69 DCR 010218 (August 12, 2022).