D.C. Mun. Regs. tit. 29, r. 29-9002

Current through Register Vol. 71, No. 44, November 1, 2024

Rule 29-9002 - ELIGIBILITY REQUIREMENTS

9002.1

To receive IFS Waiver services a person shall be currently receiving services from the Department on Disability Services/Developmental Disabilities Administration (DDS/DDA) and meet all of the following requirements:

(a) Have a special income level up to three hundred percent (300%) of the Supplemental Security Income (SSI) federal benefit or be aged and disabled with income up to one hundred percent (100%) of the federal poverty level or be medically needy as set forth in 42 C.F.R. §§ 435.320, 435.322, 435.324, or 435.330;

(b) Have a developmental disability or an intellectual disability as defined in Section 9099;

(c) Be eighteen (18) years of age or older;

(d) Be a resident of the District of Columbia as defined in D.C. Official Code §§ 7-1301.03(22);

(e) Have a Level of Care (LOC) determination that the person requires services furnished in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) or be a person with related conditions pursuant to the criteria set forth in §§ 9002.4; and

(f) Meet all other eligibility criteria applicable to Medicaid recipients including citizenship and alienage requirements.

9002.2

Waiver services shall not be furnished to a person who is an inpatient of a hospital, ICF/IID, or nursing facility.

9002.3

Each person enrolled in the Waiver shall be re-certified annually as having met all of the eligibility requirements as set forth in §§ 9002.1 for continued participation in the Waiver.

9002.4

A person shall meet the LOC determination set forth in §§ 9002.1(e) if one of the following criteria has been met, taking into consideration the standard error of measurement for the intelligence quotient (IQ) test:

(a) The person's primary disability is an intellectual disability with an IQ of fifty-nine (59) or less; or

(b) The person's primary disability is an intellectual disability with an IQ of sixty (60) to seventy (70), and the person has at least one (1) of the following conditions:

(1) Mobility deficits;

(2) Sensory deficits;

(3) Chronic health needs;

(4) Behavioral challenges;

(5) Autism;

(6) Cerebral Palsy;

(7) Epilepsy; or

(8) Spina Bifida; or

(c) The person's primary disability is an intellectual disability with an IQ of sixty (60) to seventy (70), or the person has a developmental disability, either of which results in substantial functional limitations in at least three (3) of the following major life activities:

(1) Self-Care;

(2) Understanding and use of language;

(3) Functional academics;

(4) Social skills;

(5) Mobility;

(6) Self-direction;

(7) Capacity for independent living; or

(8) Health and safety.

D.C. Mun. Regs. tit. 29, r. 29-9002

Final Rulemaking published at 69 DCR 10229 (8/12/2022); amended by Final Rulemaking published at 71 DCR 10475 (8/23/2024)