9702.1 To be eligible to receive reimbursement for ADHP services, a Provider shall:

1. (a) Submit a Medicaid Provider Enrollment Application to DHCF, and comply with the requirements set forth in Chapter 94 (Medicaid Provider and Supplier Screening, Enrollment, and Termination) of Title 29 DCMR;
2. (b) Comply with the programmatic, staffing and reporting requirements as set forth in this chapter;
3. (c) Have a valid Certificate of Need (CON) determined in accordance with the District of Columbia Health Services Planning Program Re-establishment Act of 1996, effective April 9, 1997 (D.C. Law 11-191; D.C. Official Code §§ 44-401 et seq.), and implementing regulations; and
4. (d) For providers enrolled with a Dual Eligible Special Needs Plan under the District Dual Choice Program, also meet the requirements for participation in the provider network.

9702.2 In addition to the requirements described under Subsection 9702.1, DHCF shall verify that a Provider has developed the following programmatic requirements as part of its Provider Readiness Review:

1. (a) A service delivery plan to render the services described under Section 9705;
2. (b) Policies and procedures as described in Section 9703.4;
3. (c) A staffing and personnel training plan that meets the requirements described under Section 9704; and
4. (d) A plan which demonstrates compliance with all State Plan Home and Community-Based Setting requirements pursuant to 42 C.F.R. § 441.710 (a)(1)(2).

9702.3 DHCF shall conduct an on-site Provider Readiness Review to ensure that all Providers meet the requirements described under Section 9702.

9702.4 DHCF shall also conduct subsequent visits at least annually to ensure providers continue to maintain the requirements described under this chapter.

9702.5 For out-of-state ADHP providers who are serving District of Columbia residents on the effective date of these rules, DHCF may accept the licensure and/or certification for adult day programs issued by another state if the provider also

meets the Provider Readiness Review requirements described under Section 9702.

SOURCE: Final Rulemaking published at 63 DCR 1031 (January 29, 2016); as amended by Final Rulemaking published at 69 DCR 011758 (September 30, 2022).