D.C. Mun. Regs. r. 29-10107
To be eligible for PDCS services, a Services My Way participant shall be in receipt of a service authorization for personal care aide services that specifies the amount, duration, and scope of services authorized to be provided, in accordance with 29 DCMR § 5003.
A PDS budget shall be developed based on the following methodology:
The amount resulting from the calculation described in Subsection 10107.2 shall represent the Services My Way participant's monthly Participant Directed Service (PDS) allocation amount, which shall be used to compute the participant's PDS budget. If the participant is a medically needy applicant or beneficiary that must spend down income in accordance with Section 9516 of Chapter 95 of Title 29 DCMR to be eligible for Medicaid, the participant's PDS budget shall only be approved for a six (6) month period, consistent with the participant's spend down budget period, as defined in Section 9516 of Title 29 DCMR.
A PDS budget shall be developed by the participant and authorized representative, as appropriate, with assistance from the participant's support broker.
A PDS budget shall contain the following two (2) cost components:
Participant/representative-employers shall set the hourly wage rate paid to their PDWs within the wage range established by DHCF as set forth in § 10102.9.
Funds available for purchase of individual-directed goods and services shall be those funds, if any, remaining in the PDS budget after the amount for PDCS services has been determined.
Support brokers shall be responsible for explaining the method used to develop the monthly PDS allocation amount to Services My Way participants.
DHCF shall calculate the monthly PDS allocation amount for all Services My Way participants.
DHCF or its agent shall notify all Services My Way participants each time PDS allocation amounts are adjusted as a result of a change to the hourly rate paid by DHCF for personal care aide services.
The participant and the authorized representative, if applicable, shall work with the support broker to develop the participant's PDS budget based on the allocation amount.
The participant's support broker shall submit the participant's completed PDS budget to DHCF or its designee for approval within the timeframe established by DHCF.
DHCF or its designee shall review all PDCS services and individual-directed goods and services requested in a participant's PDS budget. All PDCS services requested in a PDS budget shall be reviewed in accordance with all relevant provisions of the Fair Labor Standards Act, 29 USC §§ 201et seq., and attendant regulations.
If DHCF or its designee denies any PDCS service or individual-directed good or service requested in a participant's PDS budget, DHCF or its designee shall send written notice of the denial to the participant, authorized representative as appropriate, and the participant's support broker. The notice shall contain information on the reconsideration process, as described in § 10108, and the participant's appeal rights.
Once a participant's PDS budget is approved by DHCF or its designee it shall provide the approved PDS budget to the VF/EA FMS-Support Broker entity.
The VF/EA FMS-Support Broker entity shall only release payment for PDCS services and individual-directed goods and services included in the participant's approved PDS budget and for which prior authorizations have been issued.
D.C. Mun. Regs. r. 29-10107