D.C. Mun. Regs. tit. 29, § 9902
9902.1 Medicaid reimbursable Home Health Aide services are services that are required by a beneficiary due to an illness or injury, and include assistance with activities of daily living, assistance with self-administered medications, or other clinical tasks to assist with the provision of nursing or skilled services such as cleaning around a feeding tube and assistance with oxygen therapy, on a part-time or intermittent basis.
9902.2 In order to be eligible for Medicaid reimbursement, a Home Care agency providing Home Health Aide services shall meet all requirements of Subsection 9901.2.
9902.3 Medicaid reimbursable Home Health Aide services shall be provided by a home health aide certified in accordance with Chapter 93 (Home Health Aides) of Title 17 DCMR, who is supervised in accordance with the District of Columbia Health Occupations Revision Act of 1985, as amended, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code §§ 3-1201.01 et seq.) and implementing rules.
9902.4 Medicaid reimbursable Home Health Aide services shall consist of the following duties:
(a) Performing personal care including assistance with activities of daily living such as bathing, personal hygiene, toileting, transferring from the wheelchair, and instrumental activities such as meal preparation, laundry, grocery shopping, and telephone use;
(b) Changing urinary drainage bags;
(c) Assisting the beneficiary with transfer, ambulation, and exercise as prescribed;
(d) Assisting the beneficiary with self-administration of medication;
(e) Measuring and recording temperature, pulse, respiration, and blood pressure;
(f) Measuring and recording height and weight;
(g) Observing, recording, and reporting the beneficiary's physical condition, behavior, or appearance;
(h) Preparing meals in accordance with dietary guidelines;
9902.5 Home Health Aide services shall be reimbursed by Medicaid for up to four (4) hours per day with prior authorization by DHCF, in accordance with the requirements set forth under Subsection 9902.6. The need for continuing Home Health Aide services shall be reassessed and certified by the physician every sixty (60) days.
9902.6 A beneficiary and his/her physician shall obtain prior authorization for the initiation of Medicaid reimbursable Home Health Aide services by submitting a physician's order as described in Section 9900 to DHCF or its agent to support the beneficiary's need for Home Health Aide services which aligns with the beneficiary's assessed needs.
9902.7 The Home Care agency shall initiate Home Health Aide services no later than twenty-four (24) hours after completing the plan of care, as described in Subsection 9900.11, unless the beneficiary's health or safety warrants the need for more immediate service initiation or the beneficiary or beneficiary's representatives agree to begin the services at a later date.
9902.8 The Home Care agency shall obtain prior authorization for continuing Medicaid reimbursable Home Health Aide services every sixty (60) calendar days by submitting an updated physician's order and any supporting documentation to
DHCF or its agent to support the beneficiary's need for ongoing Home Health Aide services which aligns with the beneficiary's assessed needs, as outlined in the updated plan of care.
9902.9 DHCF may authorize additional hours of Medicaid reimbursable Home Health Aide services above the four (4) hour per day limit for a beneficiary if DHCF determines that:
(a) Additional hours are medically necessary as reflected on the physician's order described in Subsections 9900.7 through 9900.9;
(b) The beneficiary's needs can be safely met in the home; and
(c) The beneficiary's Medicaid-funded services are being delivered in a cost-effective manner appropriate to the beneficiary's level of care.
9902.10 For dates of service prior to January 1, 2017, providers shall be reimbursed five dollars and two cents ($5.02) per unit of service for allowable Home Health Aide services as authorized in the approved plan of care, of which no less than three dollars and forty six cents ($3.46) per fifteen (15) minutes for services rendered by a home health aide shall be paid to the home health aide to comply with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01 et seq. (2016 Repl.)).
9902.11 For dates of service beginning January 1, 2017, providers shall be reimbursed five dollars and five cents ($5.05) per unit of service for allowable Home Health Aide services as authorized in the approved plan of care, of which no less than three dollars and forty-nine cents ($3.49) per fifteen (15) minutes for services rendered by a home health aide shall be paid to the home health aide to comply with the Living Wage Act of 2006, effective June 8, 2006 (D.C. Law 16-118; D.C. Official Code §§ 2-220.01 et seq. (2016 Repl.)).
9902.12 Subsequent changes to the reimbursement rate(s) shall be posted on the Medicaid fee schedule at www.dc-medicaid.com and DHCF shall also publish a notice in the D.C. Register which reflects the change in the reimbursement rate(s).
9902.13 If a beneficiary is receiving Adult Day Health Program (ADHP) services under Chapter 97 of Title 29 DCMR on the same day that Home Health Aide services are delivered, the combination of Medicaid reimbursable ADHP and Home Health Aide services shall not exceed a total of twelve (12) hours per day.
9902.14 A beneficiary shall not receive Personal Care Aide (PCA) services under Chapter 42 or Chapter 50 of Title 29 DCMR and Home Health Aide services concurrently. Medicaid claims for PCA services submitted by a provider for any hour in which
the beneficiary was receiving Medicaid reimbursable Home Health Aide services shall be denied.
SOURCE: Final Rulemaking published at 65 DCR 0418 (January 19, 2018); as amended by Errata Notice published at 70 DCR 014641 (November 3, 2023).