D.C. Mun. Regs. tit. 29, r. 4218

Current through Register 71, No. 45, November 7, 2024

Rule 4218 - REIMBURSEMENT RATES: ADULT DAY HEALTH

4218.1

The reimbursement rate for adult day health services during Waiver Year 5 and Waiver Year 1 of the Renewal shall be a per-diem rate of one hundred and twenty five dollars and seventy eight cents ($125.78).

4218.2

A provider shall not be reimbursed for adult day health services if the beneficiary enrolled in the waiver is concurrently receiving the following services:

(a) Intensive day treatment or day treatment mental health rehabilitative services (MHRS) under the District of Columbia State Plan for Medical Assistance (State Plan);

(b) Personal Care Aide services; (State Plan or Waiver);

(c) Services funded by the Older Americans Act of 1965, approved July 14, 1965 ( Pub. L. No. 89-73, 79 Stat. 218); or

(d) 1915(i) State Plan Option services under the State Plan.

4218.3

If a beneficiary is eligible for adult day health services under the Waiver and intensive day treatment MHRS, a provider shall not be reimbursed for adult day health services if the beneficiary is receiving intensive day treatment mental health rehabilitation services on the same day, or during a twenty- four (24) period that immediately precedes or follows the receipt of adult day health services.

4218.4

Adult day health services shall not be provided for more than five (5) days per week and for more than eight (8) hours per day.

4218.5

Adult day health services may be used in combination or on the same day as PCA services, as long as these services are not billed "concurrently" or during the same time.

4218.6

When a beneficiary enrolled in the EPD Waiver is receiving PCA and adult day services on the same day, the combination of both PCA and adult day services shall not exceed a total of sixteen (16) hours per day.

D.C. Mun. Regs. tit. 29, r. 4218

Final Rulemaking published at 64 DCR 6787 (7/21/2017)