4218.1 A provider shall not be reimbursed for adult day health services when provided concurrently with the following services:

(a) Intensive day treatment or day treatment mental health rehabilitative services (MHRS) under the District's State Plan for Medical Assistance (State Plan);

(b) Personal Care Aide services;

(c) Services funded by the Older Americans Act of 1965, approved July 14, 1965 (Pub. L. No. 89-73, 79 Stat. 218); or

(d) 1915(i) State Plan Adult Day Health Program (ADHP).

4218.2 DHCF shall not reimburse for adult day health services when the beneficiary receives intensive day treatment MHRS:

(a) On the same day as adult day health services; or

(b) During the twenty-four (24) period immediately preceding or following the receipt of adult day health services.

4218.3 Adult day health services shall not be provided for more than eight (8) hours per day, five (5) days per week.

4218.4 Adult day health services may be used in combination or on the same day as PCA services, as long as these services are not billed concurrently or during the same time.

SOURCE: Final Rulemaking published at 50 DCR 9025 (October 24, 2003); 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).