1924 FAMILY TRAINING SERVICES

1924.1 This section shall establish conditions of participation for Medicaid providers enumerated in § 1924.9 (“Medicaid Providers”) and family training services professionals and peer employees enumerated in § 1924.8 to provide family training services to caregivers of persons enrolled in the Home and Community-Based Services Waiver for Persons with Intellectual and Developmental Disabilities (ID/DD Waiver).

1924.2 Medicaid reimbursable family training services are training, counseling, and other professional support services offered to uncompensated caregivers who provide support, training, companionship, or supervision to persons enrolled in the ID/DD Waiver:

(a) Family training services includes instruction about treatment regimens and other services included in the plan of care, use of equipment specified in the plan of care, and includes updates as necessary to safely maintain the individual at home. Counseling may be aimed at assisting the unpaid caregiver in meeting the needs of the individual. All training and counseling must be included in the individual’s plan of care;

(b) Family training services are available both as a 1:1 service for a person, and in small group settings not to exceed 1:4, based upon the recommendation of the person’s support team as reflected in the person’s Individual Support Plan (ISP). For persons enrolled in small group family training services, the provider must make every effort to match the person with another person or persons of his or her choosing, or with a person who has similar skills or interests;

(c) Family training services may be provided by professionals or peer employees who meet the qualification at 1906.3; and

(d) A person served through the ID/DD Waiver may utilize both 1:1 and small group family training services, and services provided by professionals and qualified peer employees subject to the limitations in Subsection 1924.14.

1924.3 Uncompensated caregivers include any family member, neighbor, friend, companion, or co-worker who regularly provides uncompensated care to the person.

1924.4 In order to be eligible for reimbursement, each Medicaid provider must obtain prior authorization from the Department on Disabilities Services (DDS) prior to providing, or allowing any professional to provide, family training services. In its request for prior authorization, the Medicaid provider shall document the

following:

(a) The ID/DD Waiver participant's need for additional, uncompensated support;

(b) The family training services professional who will provide the family training services; and

(c) The individual caregivers who will receive the family training services.

1924.5 In order to be eligible for Medicaid reimbursement, each family training services professional shall conduct an assessment of family training needs within the first four (4) hours of service delivery, and shall develop a training plan with training goals and techniques that will assist the ID/DD Waiver participant's unpaid caregivers. The training plan shall include measurable outcomes and a schedule of approved family training services to be provided, and shall be submitted by the Medicaid provider to DDS before services are delivered.

1924.6 To be eligible for Medicaid reimbursement, each Medicaid provider shall document the following in the IDD Waiver participant's ISP and Plan of Care:

(a) The date and amount of family training services provided;

(b) The nature of the family training services provided;

(c) The name of the professional who provided the family training services;

(d) The name of the individual caregivers who received the family training services; and

(e) Family training services may be delivered through remote supports to the extent the recommended service delivery is through remote supports services, and the person is able to utilize equipment/technology needed for remote supports services as assessed and determined by the support team.

1924.7 Medicaid reimbursable family training services shall include the following activities:

(a) Instruction about treatment regimens and other services included in the person's ISP and Plan of Care;

(b) Instruction on the use of equipment specified in the person's ISP and Plan of Care;

(c) Counseling aimed at assisting the unpaid caregiver in meeting the needs of the person; and

(d) Follow up training necessary to safely maintain the person at home.

1924.8 Medicaid reimbursable family training services shall be provided by either professionals or peer employees as follows:- (a) Professionals shall be qualified as at least one (1) of the following:

- (1) Special Education Teacher;

- (2) Licensed Graduate Social Worker;

- (3) Licensed Clinical Social Worker;

- (4) Physical Therapist;

- (5) Occupational Therapist;

- (6) Registered Nurse; or

- (7) Speech Pathologist.

- (b) Peer employees shall meet the basic requirements set forth in 29 DCMR § 1906.3.1924.9 In order to be eligible for Medicaid reimbursement, each family training services professional shall be employed by the following Medicaid providers:- (a) An ID/DD Waiver Provider enrolled by DDS; or

- (b) A Home Health Agency as defined in Section 1999 of Chapter 19 of Title 29 of the DCMR.1924.10 Each Medicaid provider shall comply with Section 1904 (Provider Qualifications) and Section 1905 (Provider Enrollment Process) of Chapter 19 of Title 29 of the DCMR.1924.11 Each Medicaid provider shall maintain the following documents for monitoring and audit reviews:- (a) A copy of the most recent DDS approved ISP and Plan of Care, which shall include the documentation required by § 1924.6;

- (b) The training plan developed in accordance with the requirements of § 1924.5 ; and

(c) The documents required to be maintained under Section 1909 (Records and Confidentiality of Information) of Chapter 19 of Title 29 of the DCMR.

1924.12 Each Medicaid provider shall comply with Section 1908 (Reporting Requirements) and Section 1911 (Individual Rights) of Chapter 19 of Title 29 of the DCMR.

1924.13 Medicaid reimbursement shall not be available when family training services that are included in a person’s ISP are provided concurrently with the following ID/DD Waiver services:

(a) Supported living and supported living with transportation, with the exception of family training services which may be provided to uncompensated caregivers for people receiving supported living periodic or supported living with transportation periodic services;

(b) Residential habilitation; or

(c) Host home without transportation.

1924.14 Medicaid reimbursable family training services shall not exceed a total of four (4) hours per day and one hundred (100) hours per year. Any hours in excess of these limits must be pre-approved by DDS pursuant to § 1924.15.

1924.15 In order to be eligible for Medicaid reimbursement, professionals requesting pre-approval from DDS to provide family training services in excess of four (4) hours per day and one hundred (100) hours per year must demonstrate the need for such services. The decision of DDS to approve or disapprove the request for additional services, in whole or in part, shall be final.

1924.16 The billable unit of service for Medicaid reimbursable family training 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 in order to be able to bill a unit of service.

1924.17 Each provider of remote family training services shall comply with the requirements of Section 1943 (Remote Supports Services) of Chapter 19 of Title 29 of DCMR.

1924.18 Remote Family training 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 family training hours where two (2) service authorizations are issued to cover the in-person service hours and the remote supports service hours.

1924.19 Remote family training services reimbursement rates shall reflect the same rates as professional in-person family training reimbursement rates.

1924.20 HCBS Waiver providers providing family training through remote supports services must meet the criteria, as specified at § 1943.

SOURCE: Final Rulemaking published at 61 DCR 230 (January 10, 2014); as amended by Final Rulemaking published at 63 DCR 5232 (April 8, 2016); 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 71 DCR 010372 (August 16, 2024).