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When used in this chapter, the following terms and phrases shall have the meanings ascribed below:

Abuse - Provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in an unnecessary cost to the District Medicaid program, or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.

Activities of Daily Living (ADLs) - The ability to bathe, transfer, dress, eat and feed oneself, engage in toileting, and maintain bowel and bladder control (continence).

Admissions Hold - A process by which a provider is prohibited from admitting new waiver beneficiaries.

Advanced Practice Registered Nurse - A person who is licensed or authorized to practice as an advanced practice registered nurse pursuant to the 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.).

Assisted Living Facility - An entity that shall have the same meaning as set forth in D.C. Official Code § 44-102.01(4).

Case Management Agency - An agency under contract with the Department of Health Care Finance to provide case management services to waiver beneficiaries.

Case Manager - A staff person from the case management agency who performs case management services.

Change in Service - A request to modify the type, amount, duration, or scope of services based on the beneficiary’s current level of functioning, which is supported by the assessment tool.

Chore Aide - A person who performs tasks intended to place the home environment in a clean, sanitary, and safe condition, and to prepare the home environment for ongoing routine home care services.

Communicable Disease - Any disease defined in D.C. Official Code § 7-132 and 22-B DCMR § 299.

Cueing - Using verbal prompts in the form of instructions or reminders to assist beneficiaries with activities of daily living.

Discharge - A request to release a beneficiary from a particular service provider.

Environmental Accessibility Adaptation - Physical adaptations to the home that are necessary to ensure the health, welfare, and safety of the individual, or that enable the individual to function with greater independence in the home, and without which, the individual would require institutionalization.

EPD Waiver - The District's 1915(c) Home and Community Based Services Waiver for the Elderly and Persons with Disabilities as approved by the Centers for Medicare and Medicaid Services.

Family - Any person related to the beneficiary by blood, marriage, or adoption.

Fraud - An intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or herself or some other person, including any act that constitutes fraud under federal or District law.

Home Care Agency - An entity licensed pursuant to 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.)

Initiating services - A request to add services that has been approved as part of a beneficiary's PCSP.

Licensed Independent Clinical Social Worker - A person who is licensed or authorized to practice as an independent clinical social worker pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201 et seq.).

Limited English Proficient Individuals - Individuals who do not speak English as their primary language, and individuals who have a limited ability to read, write, speak, or understand English.

Medicaid - A federal-state program established by Title XIX of the Social Security Act, which provides payment of medical expenses for eligible persons who meet income and/or other criteria.

Natural Home - A home owned or leased by the beneficiary, the beneficiary's family member or another private individual; the lease/deed must be held by the beneficiary, the beneficiary's family member, or another private individual.

Participant/Representative-Employer - The Services My Way participant or the participant's authorized representative, as applicable, who performs employer-related duties including recruiting, hiring, supervising, and discharging participant-directed workers.

Person-Centered Service Plan - Individualized service plan developed by the case

manager that identifies the supports and services to be provided to the person enrolled in the Waiver and the evaluation of the person's progress on an on-going basis to assure that the person's needs and desired outcomes are being met.

Personal Care Aide - A person who has successfully completed the relevant jurisdiction's (the person's home state or District of Columbia) established training program and meets the competency evaluation requirements. Tasks include assistance with activities of daily living and instrumental activities of daily living.

Physical Disability - A functionally determinable impairment that substantially limits an individual's ability to perform manual tasks, engage in an occupation, live independently, or walk, see, or hear.

Physician - A person who is licensed or authorized to practice medicine pursuant to the 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.).

Plan of Care - A plan prepared by the EPD Waiver service provider that outlines the service delivery plans for the services being delivered by that provider. This is also referred to as a service delivery plan.

Provider - Any entity that meets the waiver service requirements, has signed an agreement with DHCF to provide waiver services, and is enrolled by DHCF to provide services to waiver beneficiaries.

Registered Nurse - An individual who is licensed or authorized to practice registered nursing pursuant to the 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.), as amended, or licensed as a registered nurse in the jurisdiction where services are provided.

Respite Service - Services that include the provision of assistance with activities of daily living and instrumental activities of daily living for waiver beneficiaries in their home or temporary place of residence in the temporary absence of the primary caregiver. Respite services may also be provided in a Medicaid-certified community setting or a group home.

Suspension - Ending the delivery of services to a beneficiary for a temporary period not to exceed thirty (30) calendar days.

Termination - The discontinuation of services under the Waiver or a disenrollment from the EPD Waiver Program.

Theft - Wrongfully obtaining or using the property of another with intent to deprive the other of a right to the property or a benefit of the property or to appropriate the property to an individual's own use or to the use of a third person.

Transfer - A request to move a beneficiary from one service provider to another service provider.

Vendor - A corporate entity providing individual-directed goods or services.

Vendor Fiscal/Employer Agent Financial Management Services Support Broker - An entity operating in accordance with 26 U.S.C. § 3504 and Rev. Proc. 70-6, as modified by REG-137036 and Rev. Proc. 2013-39, which provides financial management services and information and assistance services to Services My Way participants and their representatives, as appropriate.

Waiver – See EPD Waiver.

Waiver Period - Each five (5) year term for which the Waiver is approved by CMS, beginning with the initial effective date of the Waiver.

Wrongfully Obtain or Use - Taking or exercising control over property; making an unauthorized use, disposition, or transfer of an interest in or possession of property; or obtaining property by trick, false pretense, false token, tampering, or deception. The term “wrongfully obtain or use” includes conduct previously known in the District as larceny, larceny by trick, larceny by trust, embezzlement, and false pretenses.

SOURCE: Final Rulemaking published at 50 DCR 9025 (October 24, 2003); as amended by Final Rulemaking published at 54 DCR 9125 (September 21, 2007); 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).