4233.1 In order to be reimbursed by Medicaid, homemaker services must be provided by the following Medicaid-enrolled providers:

1. (a) A home care agency which meets the conditions of participation for home care agencies as set forth in 42 CFR part 484, by being enrolled as a Medicare provider, and complying with the requirements set forth in the Health-Care and Community Residence Facility, Hospice, and Home Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48; D.C. Official Code §§ 44-501 et seq.); or
2. (b) A business with a general business license issued by the D.C. Department of Consumer and Regulatory Affairs (DCRA) to perform housekeeping services in the District of Columbia.

4233.2 In order to receive Medicaid reimbursement for homemaker services, all individual homemaker service staff shall:

1. (a) Be at least eighteen (18) years of age;
2. (b) Be able to successfully communicate with the beneficiary receiving EPD Waiver services;
3. (c) Pass a criminal background check;
4. (d) Obtain, and maintain an updated Cardiopulmonary Resuscitation certificate; and
5. (e) Meet the qualification and training requirements under Subsection 4233.3 or 4233.4.

4233.3 In order to receive Medicaid reimbursement for homemaker services, a home care agency shall:

1. (a) Require that all individual homemaker service staff be certified as a Home Health Aide in accordance with District of Columbia Health Occupations Revisions Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq.), and implementing rules, Chapter 93 of Title 17 DCMR; and
2. (b) Meet any ongoing training requirements required under the Department of Health's Home Health Aide certification requirements.

4233.4 In order to receive Medicaid reimbursement for homemaker services, a business with a general business license issued by the D.C. Department of Licensing and Consumer Protection to provide housekeeping services shall require that all individual homemaker staff obtain a minimum of eight (8) hours of training annually in the following areas:

(a) Beneficiary rights;

(b) Communicating effectively with beneficiaries enrolled in the waiver;

(c) Preventing abuse, neglect, and exploitation;

(d) Controlling the spread of disease and infection;

(e) Changing linens and bed bug prevention;

(f) Safe handling of cleaning chemicals (use of gloves, goggles, or masks);

(g) Handling hazardous waste;

(h) Blood-borne pathogens and bodily fluids;

(i) Food preparation, handling, and storage; and

(j) Instructions on the following:

(1) Dusting;

(2) Maintenance of floors (mopping or vacuuming);

(3) Trash handling;

(4) Laundry and safe use of detergents;

(5) Cleaning the walls and ceiling; and

(6) Kitchen and bathroom cleaning and maintenance.

4233.5 Supervisory staff employed by the homemaker service provider shall develop a written homemaker service delivery plan, which shall be approved by the beneficiary's case manager prior to implementation.

4233.6 The homemaker service provider shall document each in-home visit and telephone

contact in the beneficiary's service delivery plan within thirty (30) calendar days of the visit or contact.

4233.7 A copy of the homemaker service delivery plan shall be shared with the case manager and kept on-file at the Home Care Agency or the homemaker service provider licensed to provide housekeeping services.

4233.8 Each provider of homemaker services shall maintain comprehensive records including the service delivery plans, and records identifying dates of training and topics covered in each employee's personnel file for a period of no less than ten (10) years.

4233.9 An individualized in-service training plan shall be developed and implemented for each staff person when performance evaluations indicate a need for more training.

4233.10 A waiver beneficiary may choose an individual or family member other than a beneficiary's spouse, other legally responsible relative, or court-appointed guardian to provide homemaker services. Legally responsible relatives do not include parents of an adult child, so parents of an adult child are not precluded from providing homemaker services.

4233.11 Homemaker services shall not duplicate the duties provided through PCA services or respite services.

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).