1918.1 The purpose of this section is to establish standards governing Medicaid eligibility for Creative Arts Therapies services for persons enrolled in the Home and Community-Based Services Waiver for Individuals with Intellectual and Developmental Disabilities (Waiver), and to establish conditions of participation for providers of these services.

1918.2 Creative Arts Therapies services utilize art, dance, drama, and music therapy to provide therapeutic supports to help a person with disabilities express and understand emotions through artistic expression and the creative process. Creative Arts Therapies shall be based upon what is important to and for the person as reflected in his or her Person-Centered Thinking tools and the goals in his or her Individual Support Plan (ISP).

1918.3 Creative Arts Therapies services are available both as a one-to-one service for a person, and in small-group settings, not to exceed 1:4.

1918.4 To be eligible for reimbursement, the services shall be:

1. (a) Ordered by a physician or a practitioner listed in Subsection 1918.7;
2. (b) Reasonable and necessary for the treatment of social and emotional difficulties related to a number of mental health issues including disability, illness, trauma, loss, and physical and cognitive problems;
3. (c) Recommended by a person's support team, and included in the person's ISP and Plan of Care; and
4. (d) Creative arts therapies services may be delivered remotely (remote supports) to the extent the person is able to utilize equipment/technology needed to access Creative arts therapies services as assessed and determined by the support team.

1918.5 The types of services eligible for reimbursement shall be:

1. (a) Art therapy;
2. (b) Dance therapy;
3. (c) Drama therapy; and
4. (d) Music therapy.

1918.6 Each person providing Creative Arts Therapies services shall:

1. (a) Conduct an assessment within the first two (2) hours of delivering the service;
2. (b) Develop and implement an individualized art, dance, drama, or music plan for the person that is in keeping with their choices, goals and prioritized needs that includes the following:
3. (1) Treatment strategies including direct therapy, caregiver training, monitoring requirements and instructions, and anticipated outcomes; and
4. (2) Identification of specific anticipated and measurable, functional outcomes, based upon what is important to and for the person as reflected in his or her Person-Centered Thinking tools and the goals in his or her ISP.
5. (c) Deliver the completed plan to the person, family, guardian or other caregiver, and the Department on Disability Services (DDS) Service Coordinator prior to the Support Team meeting;
6. (d) Participate in the ISP and Support Team meetings, when invited by the person, to provide consultative services and recommendations specific to the expert content with the focus on how the person is doing in achieving the functional goals that are important to him or her;
7. (e) Provide necessary information to the individual, family, guardian or caregivers, and/or team, to assist in planning and implementing the approved ISP and Plan of Care;
8. (f) Record progress notes on each visit.
9. (g) Submit quarterly reports in accordance with the requirements in Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR;
10. (h) Conduct periodic examinations and modify treatments for the person receiving services as necessary; and
11. (i) Meet all of the requirements in Section 1906 (Requirements for Direct Support Professionals) of Chapter 19 of Title 29 DCMR.

1918.7 Services shall be provided by a certified practitioner in an

independent practice or a practitioner employed by a Waiver provider.

1918.8 Creative Arts Therapies services shall be delivered by the following practitioners:

(a) Art therapists certified to practice art therapy by the American Art Therapy Association, Inc. and/or credentialing of the Art Therapy Credentialing Board;

(b) Dance therapists authorized to practice dance therapy pursuant to Chapter 71 (Dance Therapy) of Title 17 DCMR (Business, Occupations, and Professionals);

(c) Drama therapists certified by the National Association for Drama Therapy; and

(d) Music therapists certified by the Certification Board for Music Therapists, which is managed by the American Music Therapy Association.

1918.9 Each Waiver provider or certified practitioner in an independent practice shall meet the requirements as set forth in Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 DCMR.

1918.10 Creative Arts Therapies practitioners, without regard to their employer of record, shall be selected by the person or his/her authorized representative and shall be answerable to the person receiving services.

1918.11 Any Waiver provider substituting practitioners for more than a two (2) week period or four (4) visits due to emergency or availability events shall request a case conference with the DDS Service Coordinator to evaluate continuation of services.

1918.12 Services shall be authorized for reimbursement in accordance with the following provider requirements:

(a) DDS shall provide a written service authorization before the commencement of services;

(b) The provider shall conduct an assessment and develop a Creative Arts Therapies treatment plan with training goals and techniques that will assist the careg--ivers, within the first two (2) hours of service delivery;

(c) The service name and 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 Sub section 1918.15.

1918.13 Each certified practitioner or Waiver provider shall maintain records required under Section 1908 (Reporting Requirements) and Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 DCMR.

1918.14 Each certified independent practitioner or Waiver provider shall comply with Section 1911 (Individual Rights) under Chapter 19 of Title 29 DCMR.

1918.15 Any combination of Creative Arts Therapies services shall be limited to a maximum dollar amount per person, per calendar year, and delivered in accordance with the person’s ISP and Plan of Care.

1918.16 The reimbursement rate for Creative Arts Therapies services shall be billed:

(a) Per person per forty-five (45) minutes for art, dance, drama or music therapy in a group not to exceed four (4); and

(b) Per person per forty-five (45) minutes for art, dance, drama or music therapy as an individual service.

1918.17 The billable unit of service for Creative Arts Therapies services shall be fifteen (15) minutes. A provider shall provide at least eight (8) minutes of service in a span of fifteen (15) continuous minutes to bill a unit of service. Creative Arts Therapies may be billed on the same day, but cannot be billed concurrently with day vocational services, including but not limited to Day Habilitation and Employment Readiness services.

1918.18 Each provider of remote creative arts therapies services shall comply with the requirements under Section 1943 (Remote Supports Services) of Chapter 19 of Title 29 of DCMR.

1918.19 Creative arts therapies delivered through remote supports services shall be issued as a separate service authorization indicating the frequency of usage. A hybrid model may be used for in-person and remote supports services hours, where two (2) service authorizations are issued to cover the in-person service hours and the remote supports services hours.

1918.20 Remote creative arts therapies services reimbursement rates shall reflect the same rates as professional in-person creative arts therapies reimbursement rates.

1918.21 HCBS Waiver practitioner(s) providing creative arts therapies through remote supports services must meet the criteria as specified at § 1943.

SOURCE: Final Rulemaking published at 55 DCR 2906 (March 21, 2008); as amended by Final Rulemaking published at 60 DCR 16830 (December 13, 2013); as amended by Final Rulemaking published at 62 DCR 15679 (December 4, 2015); as amended by Final Rulemaking published at 63 DCR 9096 (July 1, 2016); as amended by Final Rulemaking published at 64 DCR 7469 (August 4, 2017); as amended by Final rulemaking published at 71 DCR 010372 (August 16, 2024).