4200 GENERAL PROVISIONS: IDENTIFICATION OF SERVICES; AUTHORITY OF OPERATION; TARGETING RESTRICTIONS

4200.1 The following home and community-based waiver services are included in this chapter, consistent with the regulations set forth herein:

1. (a) Case management services;
2. (b) Personal case aide services;
3. (c) Personal emergency response system services;
4. (d) Respite services;
5. (e) Homemaker services;
6. (f) Chore aide services;
7. (g) Environmental accessibility adaptations services; and
8. (h) Assisted living services.

4200.2 The waiver services described in this chapter shall be operated or administered directly by the Medical Assistance Administration (MAA), D.C. Department of Health.

4200.3 The home- and community-based waiver services described in this chapter are furnished only to individuals who:

1. (a) Have had a determination by the MAA that the recipient is likely to require the care furnished in a nursing facility under Medicaid;
2. (b) Require assistance with activities of daily living;
3. (c) Agree to participate in the waiver program by signing a Beneficiary Freedom of Choice form;
4. (d) Are 65 or older;
5. (e) Are adults, age 18 and older, with physical disabilities;
6. (f) Are not inpatients of a hospital, nursing facility or intermediate care facility for the mentally retarded; and
7. (g) Are Medicaid eligible with a maximum monthly income of three hundred percent (300%) of Supplemental Security Income (SSI).

4200.4 Each individual receiving home and community-based waiver services described in this chapter must be determined eligible prior to the receipt of services and recertified on an annual basis. The following documents must be completed and submitted at least sixty (60) days before the expiration date of the individual's eligibility period:

(a) Form 1209-W: Annual Plan of Care Medicaid Waiver Recertification;

(b) Medicaid Level of Care; and

(c) Proof of Income and Assets.

SOURCE: Final Rulemaking published at 50 DCR 9025 (October 24, 2003); as amended by Final Rulemaking published at 54 DCR 9165 (September 21, 2007); as amended by Final Rulemaking published at 60 DCR 4827 (March 29, 2013).