4216.1 The reimbursement rate for assisted living services shall be an all-inclusive rate for all services provided, as set forth in Section 4238.

4216.2 Medicaid reimbursement will not be made for twenty-four (24) hour skilled care or skilled supervision, room and board, costs of facility maintenance, or upkeep and improvement. Covered services shall be in accordance with Section 4238.

4216.3 Beneficiaries may seek subsidies outside of the EPD Waiver to pay for room and board through the Optional State Supplemental Payment Program.

4216.4 DHCF shall not reimburse for any of the following EPD Waiver services when provided concurrently with assisted living services:

(a) Homemaker services;

(b) Chore Aide services;

(c) Respite services;

(d) Environmental Accessibility Adaptation (EAA) services; or

(e) PCA services.

SOURCE: Final Rulemaking published at 50 DCR 9025 (October 24, 2003); as amended by Final Rulemaking published at 63 DCR 4450 (March 25, 2016); as amended by Final Rulemaking published at 64 DCR 6784 (July 21, 2017); as amended by Final Rulemaking published at 72 DCR 004996 (April 25, 2025).