5000.1 These rules establish the standards and conditions of participation for home health agencies providing personal care services (Provider) under the District of Columbia Medicaid Program (Medicaid Program).

5000.2 The provisions shall be in support and furtherance of the following goals:

(a) To provide necessary hands-on personal care assistance with the activities of daily living that assist a beneficiary to safely reside in the home; and

(b) To encourage home-based care as a preferred and cost-effective alternative to institutional care.

5000.3 A Provider receiving reimbursement for personal care services shall be a home health agency and meet the conditions of participation for home health agencies set forth in Sections 1861(o) and 1891(e) of the Social Security Act and 42 CFR 484; shall be enrolled as a Medicare Provider; and shall comply with the requirements set forth in the Health-Care and Community Residence Facility Act, Hospice and Home-Care Licensure Act of 1983, effective Feb. 24, 1984 (D.C. Law 5-48; D.C. Official Code, §§ 44-501, et seq. (2005 Repl. & 2011 Supp.)), and implementing rules.

5000.4 An applicant seeking to participate as a personal care services Provider under the Medicaid Program shall submit a Medicaid Home Health Provider enrollment application to the Department of Health Care Finance (DHCF).

5000.5 Each Provider application shall contain, but not be limited to, the following:

(a) Name and address of the applicant's organization and location of the applicant's place of business. An applicant shall submit a separate application for each place of business from which the applicant intends to offer District of Columbia Medicaid program services;

(b) Answers to meet requirements as set forth in 42 C.F.R. § 455, subpart b: Disclosure of Information by Providers and Fiscal

Agents;

(c) Names of all individuals providing personal care services, license numbers and National Provider Identifier (NPI) numbers from the National Plan and Provider Enumeration System (NPPES) as of the date of the application to become a District of Columbia Medicaid Provider;

(d) The applicant's U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) Medicare Supplier Letter issued pursuant to 42 C.F.R. § 424.510 to evidence enrollment of the applicant in the Medicare program;

(e) A copy or copies of all contracts held between the applicant and any staffing agency pertaining to the delivery of personal care services;

(f) A copy or copies of license(s) held by the employees of any staffing agency or agencies used by the Provider for the delivery of personal care services;

(g) The applicant's NPI number as required by the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191);

(h) A copy of the applicant's surety bond, pursuant to requirements set forth in § 5002.2 of this title; and

(i) A copy of a Certificate of Registration or Certificate of Authority, if required by title 29 of the D.C. Official Code.

5000.6 A Provider shall submit a new Medicaid Provider enrollment application within thirty (30) days after any change in business ownership. Re-enrollment or continued enrollment in the Medicaid program after any change in business ownership shall be conditioned upon the Provider's compliance with all applicable Federal and District requirements.

5000.7 A Provider shall submit a new Medicaid Provider enrollment application and successfully re-enroll in the D.C. Medicaid program at least every five (5) years from the date of its most recent enrollment or reenrollment.

Notice of Final Rulemaking published at 59 DCR 1760, 1761 (March 2, 2012).