9723.1 Reimbursement rates shall be based on a uniform per diem rate that is differentiated based on the participant's acuity level as established by the standardized need- based assessment tool and process described under Section 9709, as follows:

(a) Acuity Level One (1) represents the health and support needs of a beneficiary whose needs based assessment reflects a minimum score of four (4); and

(b) Acuity Level Two (2) represents the health and support needs of a beneficiary whose needs based assessment reflects a score of six (6) or higher.

9723.2 Beginning April 1, 2020, the reimbursement rate for ADHP services shall be as follows:

(a) Acuity Level One (1): The daily rate for a program serving participants with minimum acuity levels with at least one staff member during all hours shall be reimbursed in accordance with the District of Columbia Medicaid Fee Schedule schedule available online at www.dc-medicaid.com; and

(b) Acuity Level Two (2): The daily rate for a program serving participants with a maximum acuity level with at least one staff member shall be reimbursed in accordance with the District of Columbia Medicaid Fee Schedule schedule available online at www.dc-medicaid.com.

9723.3 DHCF may make periodic adjustments to the uniform per-diem rates. Uniform per-diem rates may be inflated by the corresponding CMS Market Basket Index for Nursing Facilities for that period.

9723.4 All future updates to the reimbursement rates for ADHP services shall comply with the public notice requirements set forth under § 988.4 of Chapter 9 of Title 29 of the District of Columbia Municipal Regulations (DCMR) and provide an opportunity for meaningful comment.

9723.5 A public notice of ADHP rate changes shall be published in the D.C. Register at

least thirty (30) calendar days in advance of the change, and shall include a link to the Medicaid fee schedule and information on how written comments can be submitted to DHCF.

SOURCE: Final Rulemaking published at 63 DCR 1031 (January 29, 2016); as amended by Final Rulemaking published at 67 DCR 7457 (June 12, 2020).