4248.1 Individual-directed goods and services are only available to EPD Waiver beneficiaries who are enrolled as participants in the Services My Way program, and are purchased from the participant's PDS budget.

4248.2 Individual-directed goods and services are services, equipment or supplies not otherwise provided through the EPD Waiver or the Medicaid State Plan that address an identified need in the participant's PCSP, including improving and maintaining the participant's opportunities for full membership in the community. Individual-directed goods and services shall meet the following requirements in order to be reimbursed by Medicaid:

1. (a) The requested item or service would decrease the participant's need for other Medicaid services;
2. (b) The requested item or service would promote the participant's inclusion in the community; or
3. (c) The requested item or service would increase the participant's safety in the home environment.

4248.3 Allowable goods and services shall include, but not be limited to, the following:

1. (a) Cleaning services from firms or individuals to clean the participant's personal areas including bedroom, bathroom, kitchen, etc., only if necessary in addition to those services otherwise available through the EPD Waiver;
2. (b) Food preparation and delivery services, including grocery delivery and delivery of prepared foods (but not payment for the food itself);
3. (c) Transportation services not currently available under Medicaid or the District's accessible transportation programs or through natural supports that are related to activities of daily living, and meet an objective outlined in the participant's PCSP;
4. (d) Small electric appliances which allow the participant to safely prepare meals;
5. (e) Laundry services;
6. (f) The cost of changing locks at the participant's home, as necessary, when a

participant-directed worker (PDW) stops working for the participant; and

(g) Maintenance of items that meet the criteria of allowable individual-directed goods described in § 4248.2.

4248.4 Payment for allowable transportation services shall be made in the form of reimbursement for mileage documented on a Mileage Reporting Form provided by DHCF or its agent or reimbursement for public transit costs documented as specified by DHCF or its agent and submitted to the VF/EA FMS-Support Broker entity.

4248.5 For purposes of Medicaid reimbursement, non-allowable goods and services shall include, but not be limited to, the following:

1. (a) Gifts for PDWs, family or friends, including bonus payments to PDWs;
2. (b) Loans to PDWs, family or friends;
3. (c) Food, beverages and nutritional supplements;
4. (d) Entertainment equipment or supplies such as videos, VCRs, televisions, stereos, CDs, DVDs, audio and video tapes;
5. (e) Air conditioners, heaters, fans and similar items;
6. (f) Electronic devices that do not meet the requirements of § 4248.2 and do not meet an objective outlined in the participant's PCSP;
7. (g) Illegal drugs;
8. (h) Alcoholic beverages or tobacco products;
9. (i) Costs associated with advertising for prospective PDWs;
10. (j) Costs associated with travel (airfare, lodging, meals, etc.) for vacations or entertainment;
11. (k) Utility, rent or mortgage payments;
12. (l) Clothing or shoes;
13. (m) Comforters, towels, linens or drapes;
14. (n) Paint or related supplies;

1. (o) Furniture or other household furnishings;
2. (p) Cleaning or laundry for other household members or areas of a home that are not used as part of the participant's personal care;
3. (q) Large household or kitchen appliances such as washers, dryers, dishwashers, refrigerators, or freezers;
4. (r) Exercise equipment;
5. (s) Medications, vitamins or herbal supplements;
6. (t) Experimental or prohibited treatments;
7. (u) Laundry detergent and household cleaning supplies;
8. (v) Vehicle expenses, including routine maintenance, repairs, or insurance costs;
9. (w) Transportation services that are otherwise available under Medicaid or the District's accessible transportation programs or through natural supports or that are not related to activities of daily living;
10. (x) Landscaping and yard work;
11. (y) Pet care and supplies, except when provided for service animals; and
12. (z) Massages, manicures or pedicures.

4248.6 Participants in the Services My Way program may purchase individual-directed goods and services that are included in their PCSP, meet the requirements of Subsections 4248.2 and 4248.3, and are within their PDS budget to purchase.

4248.7 Individual-directed goods and services shall be documented in the participant’s PDS budget and PCSP. The participant’s support broker shall assist participants to revise their PDS budgets, as necessary, to account for new, appropriate individual-directed goods and services they would like to purchase. All revisions to a participant’s PDS budget to account for new, appropriate individual-directed goods and services shall be accompanied by justification supporting the revision.

4248.8 Upon revising a PDS budget to reflect a new individual-directed good or service, the support broker shall submit the revised PDS budget and justification to the Services My Way Program Coordinator for approval.

4248.9 The Services My Way Program Coordinator shall review all requested individual-directed goods and services.

4248.10 The VF/EA FMS-Support Broker entity shall only authorize payment of invoices submitted for individual-directed goods and services that are included in the participant's PCSP and PDS budget and that have been approved by the Services My Way Program Coordinator.

SOURCE: Final Rulemaking published at 64 DCR 6784 (July 21, 2017).