District Of Columbia 2023-2024 Regular Session

District Of Columbia Council Bill PR25-0533 Compare Versions

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Old	New	Differences
1	1	MURIEL BOWSER
2	2	MAYOR
3	3	November 14, 2023
4	4	The Honorable Phil Mendelson
5	5	Chairman
6	6	Council
7	7	of the District of Columbia
8	8	1350 Pennsylvania Avenue, NW, Suite 504
9	9	Washington,
10	10	DC 20004
11	11	Dear Chainnan Mendelson:
12	12	Enclosed for consideration and approval
13	13	by the Council of the District of Columbia, pursuant to section
14	14	31 of the Homeless Services Reform Act of 2005, effective October 22, 2005 (D.C. Law 16-35; D.C.
15	15	Official Code
16	16	§ 4-756.02), is the "Housing Supportive Services and Provider Certification Standards
17	17	Approval Resolution
18	18	of 2023 ".
19	19	The resolution would approve rules that establish requirements and procedures for the District to
20	20	administer the new l 915(i) State Plan Home and Community-Based Services Housing Supportive
21	21	Services ("HSS") benefit and conditions
22	22	of participation for entities delivering these services. HSS are
23	23	services that focus on helping District Medicaid beneficiaries who are homeless or at risk ofhomtdessness
24	24	find and maintain permanent housing in the community, build independent living and tenancy skills, and
25	25	connect them
26	26	to community resources. The benefit is targeted to people with disabilities or complex
27	27	health needs, who often experience significant barriers to accessing care and housing.
28	28	The Department operates the new HSS benefit in conjunction with the Department
29	29	of Health Care
30	30	Finance ("DHCF")
31	31	in accordance with a Fiscal Year 2022 Memorandum of Understanding between DHS
32	32	and DHCF. DHCF has adopted corresponding rules
33	33	in Chapter 103 (Medicaid Reimbursement for
34	34	Housing Supportive Services)
35	35	of Title 29 (Public Welfare) of the DCMR. These mies establish HSS
36	36	eligibility, enrollment procedures, provider requirements, provider ce1iification procedures, and rates for
37	37	provider reimbursement under the District's Medicaid program. ln addition, for the purpose
38	38	of
39	39	maintaining uniform housing-related supportive services standards between HSS and Permanent
40	40	Supportive Housing ("PSH") programs, these rules also establish reimbursement rates for PSH services in
41	41	Chapter 25.
42	42	I urge the Council to take prompt and favorable action on this proposed resolution. 1
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74	74	~~
75	75	Chairman Phil Mendelson
76	76	at the request
77	77	of the Mayor
78	78	A PROPOSED RESOLUTION
79	79	IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
80	80	To approve proposed final rules to implement the Housing Supportive Services Benefit and
81	81	Provider Certification Standards.
82	82	RESOLVED, BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
83	83	resolution may be cited as the "Housing Supportive Services and Provider Certification
84	84	Standards Approval Resolution
85	85	of 2023".
86	86	Sec.
87	87	2. Pursuant to section 31 of the Homeless Services Reform Act of 2005, effective
88	88	October 21, 2005 (D.C. Law 16-35; D.C. Official
89	89	Code§ 4-756.02), the Council approves the
90	90	proposed final rules
91	91	of the Director of the Department of Human Services to adopt a new
92	92	Chapter 74 (Housing Supportive Services and Provider Certification Standards) and amend
93	93	Chapter
94	94	25 (Shelter and Supportive Housing for Individuals and Families) of Title 29 (Public
95	95	Welfare)
96	96	of the District of Columbia Municipal Regulations, regarding the implementation of the
97	97	Housing Supportive Services and Provider Certification Standards benefit, which were
98	98	transmitted to the Council by the Mayor on
99	99	_____ _
100	100	Sec.
101	101	3. Transmittal.
102	102	The Council shall transmit a copy
103	103	of this resolution, upon its adoption, to the Mayor, the
104	104	Director
105	105	of the Department of Human Services, and the Administrator of the Office of
106	106	Documents and Administrative Issuances.
107	107	1 33 Sec. 4. Fiscal impact statement.
108	108	34 The Council adopts the fiscal impact statement in the committee report as the fiscal
109	109	35 impact statement required by section 4a of the General Legislative Procedures Act of 1975,
110	110	36 approved October 16, 2006 (120 Stat. 2038; D.C. Official Code§ 1-301.47a).
111	111	37 Sec. 5. Effective date.
112	112	38 This resolution shall take effect immediately.
113	113	2 DEPARTMENT OF HUMAN SERVICES
114	114	NOTICE OF FINAL RULEMAKING
115	115	(as submitted to the Council of the District of Columbia for its review and approval
116	116	pursuant
117	117	to section 31 of the Homeless Services Reform Act of 2005,
118	118	effective October
119	119	22, 2005 (D.C. Law 16-35; D.C. Official Code§ 4-756.02))
120	120	The Director of the Department of Human Services ("Director"), pursuant to the authority set forth
121	121	in Section
122	122	31 of the Homeless Services Reform Act of 2005, effective October 22, 2005 (D.C.
123	123	Law 16-35; D.C. Official Code§ 4-756.02), and Mayor's Order 2006-20, dated February 13, 2006,
124	124	hereby gives notice
125	125	of her adoption of the following new Chapter 74 (Housing Supportive Services
126	126	and Provider Certification Standards) and the following amendments to Chapter
127	127	25 (Shelter and
128	128	Supportive Housing for Individuals and Families)
129	129	of Title 29 (Public Welfare) of the District of
130	130	Columbia Municipal Regulations ("DCMR").
131	131	These rules establish standards
132	132	to administer the new 1915(i) State Plan Home and Community
133	133	Based Services Housing Supportive Services ("HSS") benefit and conditions
134	134	of participation for
135	135	entities delivering these services. HSS are services that focus on helping District Medicaid
136	136	beneficiaries who are homeless or at risk
137	137	of homelessness find and maintain permanent housing in
138	138	the community, build independent living and tenancy skills, and connect them to community
139	139	resources. The benefit is targeted to people with disabilities or complex health needs, who often
140	140	experience significant barriers to accessing care and housing.
141	141	The Department operates the new HSS benefit in conjunction with the Department
142	142	of Health Care
143	143	Finance ("DHCF") in accordance with a Fiscal Year 2022 Memorandum
144	144	of Understanding
145	145	between DHS and DHCF. DHCF has adopted corresponding rules in Chapter
146	146	103 (Medicaid
147	147	Reimbursement for Housing Supportive Services)
148	148	of Title 29 (Public Welfare) of the DCMR.
149	149	These rules establish HSS eligibility, enrollment procedures, provider requirements, provider
150	150	certification procedures, and rates for provider reimbursement under the District's Medicaid
151	151	program. In addition, for the purpose
152	152	of maintaining uniform housing-related supportive services
153	153	standards between HSS and Permanent Supportive Housing ("PSH") programs, these rules also
154	154	establish reimbursement rates for PSH services in Chapter 25.
155	155	An initial Notice
156	156	of Emergency and Proposed Rulemaking was published in the District of
157	157	Columbia Register on June 17, 2022, at 69 DCR 7181. A second Notice of Emergency Rulemaking
158	158	was subsequently published in the
159	159	District of Columbia Register on August 5, 2022, at 69 DCR
160	160	10060. A third Notice
161	161	of Emergency Rulemaking was adopted on October 14, 2022, went into
162	162	effect at that time, and remained in effect until February
163	163	11, 2023. The third Notice of Emergency
164	164	Rulemaking was published in the
165	165	District of Columbia Register on June 2, 2023, at 70 DCMR
166	166	7991. A fourth Notice
167	167	of Emergency Rulemaking and second Notice of Proposed Rulemaking was
168	168	published in the
169	169	District of Columbia Register on June 2, 2023, at 70 DCMR 8029. These rules
170	170	are identical
171	171	to the second proposed rulemaking, in response to which the District received no
172	172	public comments.
173	173	Further, in accordance with section
174	174	31 of the HSRA (D.C. Official Code§ 4-756.02), the proposed
175	175	final rules were submitted to the Council for a forty-five (45) day period
176	176	of review and were deemed approved on September_, 2023, pursuant to PR 25-_. On September_, 2023, the
177	177	Director
178	178	of the Department adopted these rules as final, and the rules shall become effective upon
179	179	publication
180	180	of this notice in the District of Columbia Register.
181	181	A new Chapter 74, HOUSING SUPPORTIVE SERVICES AND PROVIDER
182	182	CERTIFICATION ST AND ARDS,
183	183	of Title 29 DCMR, is added to read as follows:
184	184	7400
185	185	7400.1
186	186	7400.2
187	187	7400.3
188	188	7400.4
189	189	7400.5
190	190	7400.6
191	191	CHAPTER 74 HOUSING SUPPORTIVE SERVICES AND PROVIDER
192	192	CERTIFICATION ST AND ARDS
193	193	GENERAL PROVISIONS
194	194	The mission of the Department of Human Services (Department) is to empower
195	195	every District resident to reach their full potential by providing meaningful
196	196	connections to work opportunities, economic assistance and supportive services.
197	197	The Economic Security Administration
198	198	is the administration within the Department
199	199	that
200	200	is responsible for making eligibility determinations for federally and locally
201	201	funded public assistance programs in the District, including Medicaid, the
202	202	Supplemental Nutrition Assistance Program, and the Temporary Assistance for
203	203	Needy Families program. The Family Services Administration is the administration
204	204	within the Department that
205	205	is responsible for providing homeless services such as
206	206	shelter and homelessness prevention, to meet the needs of vulnerable adults and
207	207	families to help reduce risk and promote self-sufficiency.
208	208	The purpose
209	209	of this Chapter is to establish standards for the Housing Supportive
210	210	Services (HSS) benefit, including eligibility criteria, service standards, HSS
211	211	provider certification requirements, and which services shall be reimbursed through
212	212	Medicaid.
213	213	HSS are Medicaid-reimbursable activities that include a range
214	214	of flexible housing
215	215	related services and supports for adults at risk
216	216	of or experiencing chronic
217	217	homelessness and who have a disability or disabling condition that interferes with
218	218	or limits their capacity to maintain housing stability.
219	219	Permanent supportive housing (PSH) programs provide services similar to HSS but
220	220	are funded through the District's local budget for adults who are ineligible for
221	221	Medicaid enrollment. PSH services are also available to children and youth
222	222	residing in the home
223	223	of an adult who is receiving the HSS benefit.
224	224	As provided in this Chapter, an individual is eligible to receive services through the
225	225	HSS benefit
226	226	if they are eligible for the District's PSH program and enrolled in the
227	227	District's Medicaid program.
228	228	An HSS Provider may also provide PSH services. Services and supports that do not
229	229	qualify for HSS Medicaid reimbursement
230	230	as described in this Chapter but that
231	231	2 7400.7
232	232	7400.8
233	233	7401
234	234	7401.1
235	235	7401.2
236	236	7401.3
237	237	qualify
238	238	as PSH services will generally be eligible for reimbursement by the
239	239	Department through the PSH program, pursuant
240	240	to the PSH program rules.
241	241	The HSS benefit described in this Chapter has been designed to comply with
242	242	requirements established in federal home and community-based services
243	243	regulations (
244	244	42 CFR § 441. 710) and clarified by informational bulletins published
245	245	by the U.S. Department
246	246	of Health and Human Services, Centers for Medicare and
247	247	Medicaid Services (CMS), Center for Medicaid and CHIP Services.
248	248	Each Department-certified HSS provider shall meet and adhere
249	249	to the terms and
250	250	conditions
251	251	of its PSH Human Care Agreement (HCA) with the Department.
252	252	ELIGIBLE CONSUMERS
253	253	To be determined eligible for HSS, an individual shall:
254	254	(a) Be eighteen (18) years
255	255	of age or older;
256	256	(b) Be enrolled in Medicaid or meet the criteria described
257	257	at§ 7401.4;
258	258	(c) Be a resident
259	259	of the District as defined in section 2(32) of the Homeless
260	260	Services Reform Act
261	261	of 2005, as amended (D.C. Official Code §4-
262	262	751.01(32));
263	263	(d) Have a documented disability or disabling condition;
264	264	( e) Be experiencing housing instability as evidenced by one
265	265	of the following
266	266	risk factors:
267	267	(1) Chronic homelessness;
268	268	(2) At risk
269	269	of chronic homelessness; or
270	270	(3) History
271	271	of chronic homelessness and for whom providing HSS will
272	272	prevent a return
273	273	to homelessness; and
274	274	(t) Be determined eligible for PSH services through the District's Coordinated
275	275	Assessment Housing Placement system.
276	276	An individual who
277	277	is seventeen (17) years old or younger who lives in the
278	278	household
279	279	of an adult participating in the HSS benefit may qualify for PSH
280	280	services.
281	281	An HSS Provider shall not receive Medicaid reimbursement under this Chapter for
282	282	supportive services provided to an individual who does not meet the eligibility
283	283	requirements set forth in subsection 7401.1.
284	284	3 7401.4
285	285	7402
286	286	7402.1
287	287	7402.2
288	288	7402.3
289	289	7402.4
290	290	7402.5
291	291	For individuals seeking enrollment in the District's Medicaid program or whose
292	292	Medicaid coverage has lapsed:
293	293	(a) There is an eligibility grace period
294	294	of ninety (90) calendar days from the
295	295	date
296	296	of first service for new enrollees, or from the date of eligibility
297	297	expiration for enrollees who have a lapse in Medicaid coverage, until the
298	298	date
299	299	an eligibility or renewal determination is made;
300	300	(b)
301	301	If the individual appeals a denial of Medicaid eligibility or renewal, the
302	302	Director
303	303	of the Department (Director) may extend the ninety (90) calendar
304	304	day eligibility grace period until the appeal has been exhausted. The ninety
305	305	(90) calendar day eligibility grace period may also be extended
306	306	at the
307	307	discretion
308	308	of the Director for other good cause shown;
309	309	(
310	310	c) Upon expiration of the eligibility grace period, HSS provided to the
311	311	individual are
312	312	no longer reimbursable by Medicaid; and
313	313	(
314	314	d) Nothing in this section alters the District's timely filing requirements for
315	315	claim submissions described at 29 DCMR § 900.
316	316	HSS -GENERAL
317	317	HSS are wrap-around services rendered by Department-certified HSS Providers to
318	318	eligible individuals who require home and community-based services to assist with
319	319	achieving and maintaining housing.
320	320	HSS shall assist an individual in mitigating their barriers
321	321	to securing and
322	322	maintaining housing and support the individual in achieving their housing-related
323	323	goals.
324	324	HSS are activities that:
325	325	(a) Support an individual's preparation to secure housing, known as Housing
326	326	Navigation; and
327	327	(b) Assist with an individual's tenancy m housing, known
328	328	as Housing
329	329	Stabilization.
330	330	HSS shall be undertaken as a partnership between the HSS Provider, the individual,
331	331	and, as appropriate, other providers and agencies.
332	332	HSS providers are entities certified in compliance with the standards set forth in
333	333	this Chapter.
334	334	4 7402.6
335	335	7402.7
336	336	7402.8
337	337	7402.9
338	338	7403
339	339	7403.1
340	340	7403.2
341	341	As set forth at 42 CFR § 441.700 to § 441.745, an individual participating or
342	342	seeking enrollment in the HSS benefit shall receive a conflict-free assessment
343	343	of
344	344	their functional needs and service plan development. The person that completes the
345	345	assessment and develops the service plan with the individual shall not be employed
346	346	by the same organization that will deliver HSS to the individual.
347	347	As further set forth at 42 CFR § 441.725(a)(6), individuals that receive HSS have
348	348	the right to choose their HSS provider.
349	349	HSS coverage limitations are set forth in § 7421. Coverage for any HSS
350	350	is
351	351	contingent on whether all the following criteria are met:
352	352	(a) The service shall be delivered to or on behalf
353	353	of a person that meets HSS
354	354	eligibility criteria for HHS,
355	355	as described at§ 7401;
356	356	(b) The service shall be delivered through a Department-certified HSS
357	357	provider;
358	358	(
359	359	c) The service shall be rendered pursuant to the applicable service-specific
360	360	standards set forth in this Chapter; and
361	361	(
362	362	d) The service shall be delivered in accordance with an approved individual
363	363	service plan.
364	364	The service-specific standards described in this Chapter apply to the HSS offered
365	365	by each HSS provider and reimbursed by the District in accordance with this
366	366	Chapter.
367	367	HOUSING NAVIGATION SERVICES
368	368	Housing Navigation Services help an individual plan for, find, and move to housing
369	369	of their own in the community.
370	370	Housing Navigation Services include assisting the individual to:
371	371	(a) Obtain key documents needed for the housing application process;
372	372	(b) Complete the housing application process, including following up with key
373	373	partners (such
374	374	as landlords and government agencies) to ensure receipt and
375	375	processing
376	376	of documents;
377	377	(
378	378	c) Complete the housing search process, including helping the individual
379	379	identify neighborhood and unit needs and preferences, potential barriers (to
380	380	avoid applying for units for which they will be screened out), helping
381	381	identify possible units, and assisting the individual to view units
382	382	as needed;
383	383	5 7404
384	384	7404.1
385	385	7404.2
386	386	(d) Identify resources to cover expenses such as security deposit, moving costs,
387	387	furnishings, adaptive aids, environmental modifications, moving costs and
388	388	other one-time expenses not covered by Medicaid;
389	389	(
390	390	e) Coordinate a unit inspection with the DC Housing Authority and the
391	391	housing provider or landlord to ensure a unit
392	392	is safe and ready for habitation;
393	393	( t) Arrange for and support the details
394	394	of the move;
395	395	(g) Develop a housing support crisis plan that includes prevention and early
396	396	intervention services when housing
397	397	is jeopardized; and
398	398	(h) Request an assessment of long-term home and community-based services
399	399	and supports.
400	400	HOUSING STABILIZATION SERVICES
401	401	After the individual has executed a rental lease agreement with the landlord of a
402	402	housing unit, and moved into that unit, the individual enters the Housing
403	403	Stabilization phase.
404	404	Housing Stabilization Services help an individual sustain living in their own
405	405	housing in the community. They include assisting the individual
406	406	to:
407	407	(a) Identify and build on strengths that are important to maintain housing in the
408	408	community;
409	409	(b) Obtain early identification
410	410	of and intervention for behaviors that may
411	411	jeopardize housing;
412	412	(
413	413	c) Obtain education and training on the roles, rights and responsibilities of the
414	414	tenant and landlord;
415	415	(d) Develop and maintain key relationships with the individual's landlord, with
416	416	a goal
417	417	of fostering successful tenancy;
418	418	(
419	419	e) Resolve disputes with landlords and/or neighbors to reduce risk of eviction
420	420	or other adverse action;
421	421	(t) Prepare a household budget;
422	422	(g) Enroll and obtain public benefits for which the individual is eligible for
423	423	(e.g., SNAP benefits, Veterans Affairs benefits, etc.);
424	424	(h) Identify and leverage natural community supports ( e.g., family, friends,
425	425	recreational clubs, support groups, etc.);
426	426	6 7404.3
427	427	7405
428	428	7405.1
429	429	(i) Learn independent living skills and activities
430	430	of daily living ( e.g., cooking,
431	431	housekeeping, basic finances, shopping, etc.);
432	432	G) Navigate the District's housing voucher recertification process;
433	433	(k) Review, update and modify their housing support and crisis plan on a
434	434	regular basis
435	435	to reflect current needs and address existing or recurring
436	436	housing retention barriers;
437	437	(1) Advocate for and access community resources to prevent eviction; and
438	438	(m) Help re-locate
439	439	to another housing unit, if warranted.
440	440	Housing Stabilization Services also include assisting
441	441	an individual to:
442	442	(a) Identify and access available community resources (e.g., food, toiletries,
443	443	household supplies, or transportation assistance);
444	444	(b) Connect to employment, education, volunteering, and/or other community
445	445	programming and resources ( e.g
446	446	., recreation centers, public libraries,
447	447	recreational clubs, or support groups)
448	448	to help prevent social isolation;
449	449	(
450	450	c) Identify and leverage family, friends, recreational clubs, support groups,
451	451	and other natural community supports that support the individual's tenancy;
452	452	and
453	453	(
454	454	d) Access somatic health, mental health, and substance use services, including
455	455	assistance with:
456	456	(1) Requesting
457	457	an assessment oflong-term home and community-based
458	458	services and supports;
459	459	(2) Scheduling appointments, writing directions, or scheduling
460	460	transportation; and
461	461	(3) Following up post appointment to ensure the individual understands
462	462	their services and when their next appointments are scheduled.
463	463	CONSUMER ENROLLMENT INTO HSS
464	464	The process used to enroll individuals into the HSS benefit shall:
465	465	(a) Effectively engage and offer support to individuals with disabilities or
466	466	disabling conditions experiencing chronic homelessness, who often
467	467	experience significant barriers to accessing care and housing;
468	468	7 7405.2
469	469	7406
470	470	7406.1
471	471	7406.2
472	472	7406.3
473	473	7406.4
474	474	7406.5
475	475	7406.6
476	476	(b) Align with the District's Coordinated Assessment and Housing Placement
477	477	(CAHP) system for housing assistance for people experiencing
478	478	homelessness; and
479	479	( c) Meet federal requirements related
480	480	to Medicaid home and community based
481	481	services (HCBS), set forth at
482	482	42 CFR § 441.710 (as may be amended).
483	483	Enrollment into the Medicaid HSS benefit will follow two (2) distinct processes
484	484	depending on whether the individual to
485	485	be enrolled is a participant in the PSH
486	486	program before or after the HSS benefit was established in the District.
487	487	INDIVIDUAL ENROLLMENT INTO HSS FOR PERSONS MATCHED TO
488	488	PSH PROGRAM AFTER HSS BENEFIT IMPLEMENTATION
489	489	The Department will deploy an HSS enrollment process for individuals determined
490	490	eligible for the PSH program through the CAHP system after the implementation
491	491	of the HSS benefit.
492	492	This HSS benefit enrollment process for individuals shall follow the process
493	493	described
494	494	at§ 7406.3 through§ 7406. 15.
495	495	The individual shall first undergo homeless services screening, which is the process
496	496	to determine eligibility for the PSH program through the CAHP system. The
497	497	process begins with a homeless services provider,
498	498	as defined at§ 2(30) of the Act,
499	499	or the Department, engaging individuals who are either experiencing homelessness
500	500	or at risk
501	501	of homelessness.
502	502	After the individual
503	503	is determined eligible for PSH program, through the CAHP
504	504	system, the Department shall complete a face-to-face assessment using a
505	505	standardized screening tool to evaluate whether the individual meets the HSS
506	506	eligibility criteria described at §
507	507	7401.
508	508	The Department will conduct face-to-face assessments in a range
509	509	of settings,
510	510	including locations where people who are experiencing homelessness are staying
511	511	or accessing services, or they may conduct assessments using telehealth (e.g.,
512	512	telephone or video meeting)
513	513	to ensure this process can be completed as safely and
514	514	quickly
515	515	as possible, and to minimize disruption for the individual.
516	516	The screening tool used to inform an HSS eligibility determination shall consider
517	517	an individual's evidence
518	518	of needs related to HCBS aimed to assist with achieving
519	519	and maintaining housing, with questions
520	520	in certain domains, including:
521	521	(a) Housing and homelessness, including duration
522	522	of current or recent episodes
523	523	of homelessness;
524	524	8 7406.7
525	525	7406.8
526	526	7406.9
527	527	7406.
528	528	10
529	529	7406. 11
530	530	(b) Risks, including recent utilization of hospital emergency department or
531	531	inpatient care, crisis services, self-harm or exposure to violence, or risks
532	532	of
533	533	exploitation;
534	534	(
535	535	c) Socialization and daily functioning, including the need for money
536	536	management or assistance with self-care, lack
537	537	of meaningful daily
538	538	activities, and unhealthy or abusive relationships that are a factor resulting
539	539	in homelessness; and
540	540	(d) Health and wellness, including chronic health conditions, physical
541	541	disabilities that limit access to housing or ability to live independently,
542	542	problematic drinking or drug use, mental health disorders or cognitive
543	543	impairments, and co-occurring health, mental health and substance use
544	544	disorders.
545	545	In addition
546	546	to conducting the assessment, the Department may also meet with the
547	547	individual's current service provider(s), or other persons who have been identified
548	548	by the individual and may review existing records or information records to draw
549	549	valid conclusions about their support needs.
550	550	The Department and the individual, in consultation with others chosen by the
551	551	individual, will develop a person-centered service plan that reflects their needs,
552	552	preferences, and strengths. This plan may be updated or revised by the individual
553	553	and their HSS provider, as needed.
554	554	At least annually, the Department will meet with the HSS individual to conduct an
555	555	assessment and update their person-centered service plan.
556	556	After a person-centered service plan has been developed for the individual, the
557	557	Department will provide a list
558	558	of available Department-certified HSS providers to
559	559	the individual and assist the individual in selecting an HSS provider.
560	560	Information offered for each HSS provider shall include:
561	561	(a) Name, location, and contact information for the HSS provider;
562	562	(b) Length
563	563	of time that the entity has been certified as an HSS provider; and
564	564	(
565	565	c) Information regarding the HHS provider's capacity to address client support
566	566	needs, including services available in other languages, accommodations, or
567	567	expertise in addressing specific types
568	568	of disabilities or needs, and
569	569	information about other relevant services and supports that may be offered
570	570	by the HSS provider or its community partners.
571	571	9 7406.12
572	572	7406.13
573	573	7406.14
574	574	7406.
575	575	15
576	576	7407
577	577	7407.1
578	578	7407.2
579	579	7407.3
580	580	7407.4
581	581	7407.5
582	582	An individual may request to change their HSS provider during their annual re
583	583	evaluation, verbally or in writing, to Department staff completing the annual re
584	584	evaluation.
585	585	When an individual asks to change their HSS provider mid-year, the Department
586	586	will review the request and documentation regarding the individual's needs and
587	587	preferences and attempt to mediate.
588	588	If the individual would still like to change their HSS provider after consultation
589	589	with the Department, the Department will assist the individual with selecting a new
590	590	HSS provider, notify the individual's current and newly selected HSS providers
591	591	of
592	592	the individual's request, and notate who the new HSS provider will be and when
593	593	the re-assignment to the new HSS provider will be effective in the Department's
594	594	case note system. The Department will also host a case conference between the
595	595	existing and new HSS providers
596	596	to review the individual's transition plan.
597	597	After the individual selects their HSS provider, the Department will formally assign
598	598	the selected HSS provider to the individual by updating the individual's profile in
599	599	the Department's case note system. This pairing shall prompt the HSS provider to
600	600	begin efforts to engage the individual and begin the provision
601	601	of HSS.
602	602	INDIVIDUAL ENROLLMENT INTO HSS FOR PERSONS MATCHED TO
603	603	PSH PROGRAM BEFORE HSS BENEFIT IMPLEMENTATION
604	604	The Department will deploy an HSS enrollment process for individuals determined
605	605	eligible for the PSH program through the CAHP system prior to the start
606	606	of the HSS
607	607	benefit. This section applies to individuals who are receiving services from a PSH
608	608	Provider.
609	609	This HSS benefit enrollment shall include the steps described
610	610	at§ 7407.3 through
611	611	§ 7407.
612	612	14.
613	613	The Department shall confirm the individual is receiving PSH services. The
614	614	Department shall compile a list
615	615	of all individuals enrolled in the PSH program (PSH
616	616	Program Participant List). This list shall indicate the PSH Provider and Medicaid
617	617	enrollment status for each individual included.
618	618	The Department shall update and finalize the PSH Program Participant List with
619	619	information presented
620	620	by the PSH Provider, through correspondence with each
621	621	PSH Provider included on this list.
622	622	After the PSH Program Participant list is confirmed, the Department shall contact
623	623	each consumer on the PSH Program Participant List to select a time to conduct a
624	624	functional assessment. 7407.6
625	625	7407.7
626	626	7407.8
627	627	7407.9
628	628	7407.
629	629	10
630	630	7407.11
631	631	7407.12
632	632	7407.
633	633	13
634	634	The Department shall establish a mechanism to conduct assessments with PSH
635	635	consumers outside
636	636	of standard business hours or on a limited ad hoc basis to
637	637	accommodate PSH consumers that are only available to meet in the evenings or on
638	638	weekends, or in instances when pre-scheduling an assessment time is challenging.
639	639	After a time for conducting the functional assessment and person-centered service
640	640	plan has been determined, the Department shall: •
641	641	(a) Jointly complete a face-to-face functional assessment with the PSH
642	642	consumer, as described at § 7406.6;
643	643	(b) Provide information to the PSH consumer
644	644	to facilitate their choice of HSS
645	645	Provider; and
646	646	(c) Update the PSH consumer's existing person-centered service plan.
647	647	When needed, the Department will work closely with the PSH consumer's PSH
648	648	Provider and other trusted entities
649	649	to complete the person-centered service plan.
650	650	The Department may use telehealth (e.g., telephone or video meeting) to meet with
651	651	the PSH consumer, and with the PSH consumer's consent, this may include their
652	652	current service provider or a trusted support person.
653	653	After the Department completes the functional assessment with the PSH consumer
654	654	and updates the PSH consumer's person-centered service plan,
655	655	as needed, the PSH
656	656	consumer may receive HSS services and be considered an HSS individual.
657	657	The Department shall support the HSS individual's choice to continue to receive
658	658	services from their existing PSH provider,
659	659	if that entity is also a HSS provider, or
660	660	to select a new HHS provider. The Department shall provide HSS individuals with
661	661	a list
662	662	of providers certified to provide HSS. Information offered for each HSS
663	663	provider shall include information listed
664	664	at§ 7406.11.
665	665	If the HSS individual selects an HSS provider that is also the current PSH provider,
666	666	the Department shall confirm that the HSS individual
667	667	is linked to the HSS provider
668	668	in the Department's case note system.
669	669	If the HSS individual selects an HSS provider that is not the current PSH provider,
670	670	the Department shall notify the HSS individual's current PSH provider and newly
671	671	selected HSS provider
672	672	of the choice made, confirm the individual's transition plan
673	673	with their current PSH provider and new HSS provider, and then notate the
674	674	individual's chosen HSS provider and transition date in the Department's case note
675	675	system.
676	676	11 7407.14
677	677	7407.15
678	678	7407.16
679	679	7408
680	680	7408.1
681	681	7408.2
682	682	7408.3
683	683	If the HSS individual chooses to receive services from an HSS provider that is
684	684	different than their current provider, the current provider shall develop a transition
685	685	plan that supports the individual's successful transition to the new HSS provider.
686	686	An HHS individual's transition date from one HSS provider to another HSS
687	687	provider shall be the first day
688	688	of the month following the date in which the
689	689	individual's request
690	690	to transition is received by the Department.
691	691	The HSS provider shall continue to deliver services
692	692	to the HSS individual, if the
693	693	HSS provider was already previously delivering services to the individual
694	694	as a PSH
695	695	provider.
696	696	If the HSS provider has no immediate historical relationship with the HSS
697	697	individual
698	698	as a PSH provider, the HSS provider shall initiate services to their newly
699	699	enrolled HSS individual.
700	700	INDIVIDUAL SERVICE PLAN DEVELOPMENT
701	701	As part of the HSS benefit enrollment process described at§§ 7406 and 7407, the
702	702	Department shall develop an Individual Service Plan (ISP) for, and in collaboration
703	703	with, the individual, using a person-centric, strengths-based approach.
704	704	The ISP shall:
705	705	(a) Reflect priorities important to the individual;
706	706	(b) Consider the individual's beliefs, values, and cultural norms in how, what,
707	707	and by whom HSS are to
708	708	be provided;
709	709	(c) List appropriate and measurable goals and objectiv
710	710	es related to the
711	711	individual's desired housing-related outcomes;
712	712	(
713	713	d) Describe recommended service interventions that will address the
714	714	individual's needs; and
715	715	(
716	716	e) Serve as written guidance the individual may use in moving toward housing
717	717	stability.
718	718	The ISP shall include the following elements:
719	719	(a) Overall goal statement that captures the individual's short-and long-term
720	720	goals for the future, ideally written in first-person language. This shall
721	721	include the individual's self-identified housing-related goals;
722	722	(b) List or statement
723	723	of individual or family strengths that support goal(s)
724	724	accomplishment. These include abilities, talents, accomplishments, and
725	725	resources;
726	726	12 7409
727	727	7409.1
728	728	7409.2
729	729	7409.3
730	730	7409.4
731	731	(c) List or statement
732	732	of barriers that pose obstacles to the individual's or
733	733	family's ability to accomplish the stated goal(s). These include symptoms,
734	734	functional impairments, lack
735	735	of resources, consequences of behavioral
736	736	health issues, and other challenges; and
737	737	(
738	738	d) Statement of objectives that identify the short-term individual or family
739	739	changes in behavior, function, or status that can help overcome the
740	740	identified barriers to housing stability. Objective statements describe
741	741	outcomes that are measurable and include individualized target dates to be
742	742	accomplished within the scope
743	743	of the plan.
744	744	HSS PROVIDER REQUIREMENTS -GENERAL
745	745	Each HSS provider shall:
746	746	(a) Comply with all related federal and local confidentiality laws;
747	747	(b) Comply with all provisions
748	748	of the Homeless Services Reform Act of 2005
749	749	(HSRA or Act),
750	750	as amended, D.C. Law 16-35; D.C. Official Code § 4-
751	751	756.02 and corresponding regulations;
752	752	(c) Have and maintain a PSH Human Care Agreement (HCA) with the
753	753	Department and comply with the requirements stated in their PSH HCA;
754	754	(d) Enroll and maintain enrollment in the District's Medicaid program as an
755	755	HSS provider:
756	756	(e) Enroll eligible individuals into the Medicaid benefit and maintain monthly
757	757	enrollment
758	758	of all individuals;
759	759	(t) Submit all requested program and financial information
760	760	to the Department
761	761	for evaluation and auditing purposes; and
762	762	(g) Provide clinical management for its enrolled individuals.
763	763	Each HSS provider shall satisfy the minimum staffing requirements set forth in this
764	764	section and§ 7411.
765	765	Each HSS provider shall comply with the certification standards described in this
766	766	Chapter.
767	767	Each HSS provider shall provide to the District information that the District
768	768	determines
769	769	is reasonably necessary to:
770	770	(a) Monitor and evaluate the HSS provider's compliance with the terms of its
771	771	HCA with the Department and Medicaid Provider Agreement, including:
772	772	13 7409.5
773	773	7409.6
774	774	7409.7
775	775	7409.8
776	776	conducting claims audits, Medicaid compliance reviews, quality reviews,
777	777	and any other program integrity function
778	778	to ensure the quality, effectiveness
779	779	and efficiency
780	780	of services and ensuring the accuracy of claims submitted for
781	781	reimbursement under this agreement; and
782	782	(b) Verify the costs
783	783	of services required m the HCA, including all
784	784	administrative, direct, and indirect costs.
785	785	Each HSS provider shall have
786	786	an annual audit by an independent certified public
787	787	accountant or a certified public accounting firm in accordance with generally
788	788	accepted auditing standards. The resulting financial audit report shall be consistent
789	789	with formats recommended by the American Institute
790	790	of Public Accountants. The
791	791	HSS provider shall submit a copy
792	792	of their financial audit report to the Department
793	793	within one hundred and twenty (120) calendar days after the end
794	794	of the provider's
795	795	fiscal year.
796	796	Each HSS provider shall document all notes describing individual engagement
797	797	activities in the Department's web-based case note platform. All case notes shall be
798	798	documented using the Data Assessment and Plan (DAP) format unless otherwise
799	799	indicated by the Department.
800	800	Each HSS provider shall document each activity provided in each individual's
801	801	record in the Department's web-based case note platform to include, at minimum:
802	802	(a) A description
803	803	of the specific activity rendered and whether it should be
804	804	categorized
805	805	as supporting the consumer's Housing Navigation or Housing
806	806	Stabilization;
807	807	(b) The date and time the service(s) were rendered;
808	808	(c) The HSS provider staff member who provided the services;
809	809	(d) The setting in which the service(s) were rendered; and
810	810	(e) The individual's person-centered plan
811	811	of care provisions related to the
812	812	service(s) provided.
813	813	Each HSS Provider shall have the capacity
814	814	to receive and review information from
815	815	the District's Health Information Exchange (DC HIE) that states, at minimum, the
816	816	dates and times individuals on the HSS provider's caseload are admitted
817	817	to a
818	818	hospital, discharged from a hospital or transferred between departments within a
819	819	hospital. Information that the HSS provider receives from the DC HIE will be
820	820	emailed
821	821	to the provider in a CSV ( comma-separated values) format, such as
822	822	Microsoft Excel, or uploaded to the provider's electronic health record system (
823	823	as
824	824	applicable).
825	825	14 7409.9
826	826	7410
827	827	7410.1
828	828	7410.2
829	829	7410.3
830	830	7410.4
831	831	7410.5
832	832	7410.6
833	833	7411
834	834	7411.1
835	835	7411.2
836	836	Each HSS provider shall report any suspicion
837	837	of abuse, neglect, self-neglect, and/or
838	838	exploitation
839	839	of individuals to the Adult Protective Services Hotline. The HSS
840	840	provider shall also notify the Department in writing no later than the next business
841	841	day following the suspicion.
842	842	HSS PROVIDER REQUIREMENTS -ISP IMPLEMENTATION
843	843	The HSS provider shall monitor the individual's progress towards meeting their
844	844	ISP goals. The ISP shall be reviewed with the individual,
845	845	as needed or at a minimum
846	846	frequency defined in the HSS provider's HCA with the Department.
847	847	The HSS provider shall make person-centered and strengths-based updates to an
848	848	individual's ISP
849	849	as needed. Updates shall be made regarding the individual's needs
850	850	and shall reflect priorities important to the individual. Any updates establish or
851	851	further already established appropriate and measurable goals and objectives,
852	852	desired outcomes, and recommended service interventions that will address the
853	853	individual's needs and assist the individual in moving toward self-sufficiency and
854	854	housing stability.
855	855	The HSS provider shall make referrals
856	856	to and partner with other agencies, as
857	857	necessary and appropriate, to support individual's supportive needs, including
858	858	behavioral health (e.g., mental health, substance abuse), educational, technical and
859	859	trade supports, parenting skills and support, legal, financial, family and child
860	860	support, early intervention, and senior and disability supports.
861	861	The HSS provider shall establish referral and follow-up procedures to confirm and
862	862	track participation in all referrals made
863	863	to other agencies. Documentation of
864	864	referrals made, and referral confirmation shall be documented in the Department's
865	865	case note system.
866	866	The HSS provider shall document in the individual's record, existing in the
867	867	Department's case note system, whether an individual's court-appointed guardian,
868	868	family, or significant others participated in the development
869	869	of the ISP.
870	870	In situations where the individual does not demonstrate the capacity to sign or does
871	871	not sign their ISP, the reasons the individual does not sign shall be recorded in the
872	872	individual's record, existing in the Department's case note system, including each
873	873	date when obtaining a signature was attempted.
874	874	HSS PROVIDER REQUIREMENTS -PERSONNEL
875	875	The HSS provider shall employ the key personnel described in this Chapter, all of
876	876	whom shall meet the described requirements listed in the HSS provider's HCA with
877	877	the Department.
878	878	Key personnel include persons that fill the following positions:
879	879	15 7411.3
880	880	7411.4
881	881	(a) Program Director (or equivalent);
882	882	(b) Case Manager Supervisor; and
883	883	(
884	884	c) Case Manager ( or equivalent).
885	885	General responsibilities
886	886	of the Program Director (or equivalent) shall include:
887	887	(a) Facilitate mediation with individuals and case managers;
888	888	(b) Develop tracking systems to allow for accurate reporting;
889	889	(
890	890	c) Identify training needs and assist with training staff;
891	891	(
892	892	d) Participate in monthly District/Provider meetings;
893	893	(
894	894	e) Collaborate with the Department in the development and maintenance of
895	895	inter-and intra-agency relationships in support of the continuum of services
896	896	to individuals;.
897	897	(f) Act
898	898	as a liaison with landlords and other community organizations to build
899	899	relationships and to promote the success
900	900	of PSH Program;
901	901	(g) Maintain knowledge regarding community resources for marginalized
902	902	communities;
903	903	(h) Ensure their Agency
904	904	is following all District policies and procedures related
905	905	to homeless service programming;
906	906	(i) Coordinate and conduct intake meetings/trainings with new program staff
907	907	to explain the HSS benefit ;
908	908	(j) Develop and implement quality control and quality improvement strategies;
909	909	(k) Review applicable databases (e.g., the Department's web-based case note
910	910	platform and the Homeless Management Information System (HMIS)) for
911	911	data quality and completeness; and
912	912	(1) Conduct monitoring of program performance on a regular basis.
913	913	General responsibilities
914	914	of the Case Manager Supervisor shall include, but not be
915	915	limited to:
916	916	(a) Provide clinical oversight;
917	917	16 7411.5
918	918	(b) Monitor and track case manager engagement with individuals;
919	919	( c) Review case notes through the lens
920	920	of quality of information captured and
921	921	accuracy
922	922	of case notes, clinical lenses;
923	923	(
924	924	d) Review, evaluate, and approve participant case plans for quality and
925	925	effectiveness;
926	926	(e) Meet individually with case managers to plan and review cases, discuss
927	927	engagement strategies and evaluates the effectiveness
928	928	of the case manager
929	929	and services;
930	930	(f) Review and approve all notices issued to individuals for accuracy and
931	931	completion;
932	932	(g) Engage in case conferences with the Department to discuss cases that may
933	933	need to include more intensive case management or transfers; and
934	934	(h) Meet requirements included in the provider's HCA with the Department.
935	935	General responsibilities
936	936	of the Case Manager shall include:
937	937	(a) Serve as the case manager and service coordinator for assigned individuals;
938	938	(b) Build rapport with the individual;
939	939	(
940	940	c) Assess the individual's strengths, needs, and preferences;
941	941	(
942	942	d) Assist the individual in specifying and articulating their goals and
943	943	developing their plan
944	944	to reach them;
945	945	(
946	946	e) Meet with the individual, including engaging with the individual in the
947	947	home setting;
948	948	(f) Develop and support the individual in achieving the goals included in their
949	949	ISP;
950	950	(g) Facilitate and ensure connection to needed community services and work in
951	951	collaboration with community agencies to ensure effective communication
952	952	and individual engagement;
953	953	(h) Connect assigned individuals to, and ensure their engagement in, needed
954	954	supportive services that will address barriers and challenges they face;
955	955	(i) Track individuals engagement/participation in supportive services,
956	956	workforce development, employment training;
957	957	17 7411.6
958	958	7411.7
959	959	7411.8
960	960	7411.9
961	961	7411.10
962	962	7411.11
963	963	(j) Complete all required case notes, housing stabilization plans, documents,
964	964	files, and assigned reports related
965	965	to individual/case activity;
966	966	(k) Develop and maintain individual's records/files that comply with all federal
967	967	laws, requirements established in this Chapter and standards set forth in the
968	968	HSS provider's HCA with the Department;
969	969	(1) Complete comprehensive monthly budgets with individuals;
970	970	(m) Input individual data and program activities into designated software
971	971	database
972	972	as assigned;
973	973	(n) Prepare and issue all Notices to individuals (i.e., Exit, Termination,
974	974	Extension Notices);
975	975	(o) Enter individual housing information into HMIS and the Department's web-
976	976	based case note platform; and
977	977	(p) Fulfill requirements included in the provider's HCA with the Department.
978	978	If more than one person employed by the HSS provider will be performing case
979	979	management tasks, the HSS provider shall identify a primary case manager
980	980	responsible for coordinating and documenting the service delivery for the
981	981	individual and document the rationale.
982	982	The HSS provider shall fill a vacant key personnel position within sixty (60)
983	983	business days
984	984	of vacancy, or within the timeframe established in the provider's
985	985	HCA with the Department, whichever
986	986	is shorter.
987	987	The Department reserves the right to review the resumes
988	988	of the HSS provider's staff
989	989	upon request.
990	990	The Department will monitor compliance with the staffing requirements for all staff
991	991	through periodic audits and reserves the right to change or remove any HSS
992	992	provider or sub-provider staff based on qualifications
993	993	of personnel not meeting the
994	994	requirements.
995	995	The Department reserves the right to change or remove any HSS provider or sub
996	996	provider staff based on unsatisfactory performance at no additional cost to the
997	997	District.
998	998	Each HSS provider's key personnel shall comply with training requirements
999	999	established in its HCA with the Department.
1000	1000	18 7412 HSS PROVIDER REQUIREMENTS -HOUSING NAVIGATION
1001	1001	SERVICES
1002	1002	7412.1
1003	1003	7412.2
1004	1004	7412.3
1005	1005	7412.4
1006	1006	7412.5
1007	1007	When delivering Housing Navigation Services, the HSS provider shall:
1008	1008	(a) Initiate and sustain engagement with the individual that facilitates the
1009	1009	creation
1010	1010	of rapport with the individual; and
1011	1011	(b) Leverage its rapport with the individual to provide Housing Navigation
1012	1012	Services geared toward supporting the individual's lease-up to a housing
1013	1013	unit.
1014	1014	The HSS provider shall use multiple approaches to contact and engage with the
1015	1015	individual. In-person and telephonic outreach attempts should be made at varying
1016	1016	times
1017	1017	of day, at varying locations where the individual is known to sometimes be
1018	1018	found and shall be proactive in nature.
1019	1019	In addition to the document requirements listed in this Chapter, documentation of
1020	1020	outreach attempts shall clearly note type of attempt, and information or notes left
1021	1021	behind for the individual. Examples
1022	1022	of outreach attempts include:
1023	1023	(a) Attempting
1024	1024	to locate the individual through outreach conducted via a
1025	1025	Homeless Outreach Provider Team, State Opioid Response Team, or the
1026	1026	DC Department
1027	1027	of Behavioral Health Critical Response Team;
1028	1028	(b) Traveling to the site/location listed on the individual's most current District
1029	1029	approved standardized screening tool or listed in HMIS;
1030	1030	(c) Visiting area homeless shelter(s)
1031	1031	to locate the individual; and
1032	1032	(
1033	1033	d) Attempting to locate the individual by attending a CARP meeting attended
1034	1034	by other homeless services providers who may have information about the
1035	1035	individual.
1036	1036	While the individual is in the Housing Navigation phase, the HSS provider shall
1037	1037	engage with the individual at the frequency established in the HSS provider's HCA,
1038	1038	but at least one time per week, with a minimum
1039	1039	of two (2) face-to-face contacts
1040	1040	each month.
1041	1041	The HSS provider must document each Housing Navigation engagement with the
1042	1042	individual. The documentation shall describe, at minimum, the date and time
1043	1043	of the
1044	1044	engagement, and include the individual's housing barrier(s) addressed (lack
1045	1045	of vital
1046	1046	documents, criminal history, poor credit, or past evictions). The Department may
1047	1047	require additional documentation for each engagement with the individual.
1048	1048	19 7412.6
1049	1049	7412.7
1050	1050	7413
1051	1051	7413.1
1052	1052	7413.2
1053	1053	7413.3
1054	1054	7413.4
1055	1055	7413.5
1056	1056	7413.6
1057	1057	7414
1058	1058	7414.1
1059	1059	The HSS provider shall ensure case managers build rapport with the individuals
1060	1060	and their landlords during Housing Navigation.
1061	1061	In addition to the required minimal face-to-face frequency
1062	1062	of engagement with
1063	1063	individuals in the Housing Navigation phase, the HSS provider may maintain
1064	1064	connection with the individual via email, text, telephone, video phone or other
1065	1065	secure methods depending on the individual's preference.
1066	1066	HSS PROVIDER REQUIREMENTS -HOUSING STABILIZATION
1067	1067	SERVICES
1068	1068	After the individual has executed a rental lease agreement with the landlord of a
1069	1069	housing unit, and moved into that unit, the individual enters the Housing
1070	1070	Stabilization phase.
1071	1071	The HSS provider shall ensure continuity and effectiveness
1072	1072	of service delivery. The
1073	1073	HSS provider shall have regular contact with individuals.
1074	1074	The HSS provider shall have a minimum
1075	1075	of two (2) contacts with an individual per
1076	1076	month, where at least one
1077	1077	of these contacts shall be face-to-face with the individual.
1078	1078	The other contact may be accomplished through other interactive methods.
1079	1079	Examples include email, text, telephone, video phone, or other secure methods,
1080	1080	depending on the individual's preference, needs, and abilities.
1081	1081	The provider shall exert concerted and deliberate efforts
1082	1082	to meet with the individual
1083	1083	face-to-face in their home. The home environment is a critical factor in the
1084	1084	individual's housing stability, particularly in the areas
1085	1085	of physical and behavioral
1086	1086	health status, economic security, self-sufficiency, and compliance with lease
1087	1087	requirements.
1088	1088	The HSS provider must document each Housing Stabilization engagement with the
1089	1089	individual. The documentation shall describe, at minimum, the date and time
1090	1090	of the
1091	1091	engagement and outline goals, meeting purpose, and service(s) provided.
1092	1092	The HSS provider shall take the lead
1093	1093	to schedule all meetings with the individual
1094	1094	at a mutually agreeable time that does not conflict with an individual's work
1095	1095	schedule, medical appointments, school events, or other appointments that are part
1096	1096	of their ISP.
1097	1097	HSS PROVIDER QUALIFICATIONS
1098	1098	The HSS provider shall be established as a legally recognized entity in the District
1099	1099	of Columbia and qualified to conduct business in the District. A certificate of good
1100	1100	standing and valid basic business license, both issued by the District
1101	1101	of Columbia
1102	1102	Department
1103	1103	of Consumer and Regulatory Affairs, shall be evidence of qualification
1104	1104	to conduct business.
1105	1105	20 7414.2
1106	1106	7414.3
1107	1107	7414.4
1108	1108	7414.5
1109	1109	The HSS provider shall:
1110	1110	(a) Have a governing body with oversight responsibility for administrative and
1111	1111	programmatic policy development, monitoring and implementation;
1112	1112	(b) Comply with all applicable Federal and District laws and regulations;
1113	1113	( c) Hire personnel with the qualifications necessary to provide HSS and
1114	1114	to meet
1115	1115	the needs
1116	1116	of its enrolled consumers, as described at§ 7411;
1117	1117	(
1118	1118	d) Ensure that independently licensed qualified practitioners are available to
1119	1119	provide appropriate and adequate supervision
1120	1120	of all clinical activities; and
1121	1121	(e) Employ qualified practitioners that meet all professional requirements as
1122	1122	defined by the applicable licensing, certification, and registration laws and
1123	1123	regulations
1124	1124	of the District or the jurisdiction where services are delivered.
1125	1125	The HSS provider shall comply with the cost survey and program integrity audits
1126	1126	set forth in Chapter
1127	1127	103 of Title 29 DCMR.
1128	1128	The HSS provider shall obtain background check documents for all persons
1129	1129	employed by the HSS provider, including subcontracted staff or any volunteers
1130	1130	with direct contact with program individuals, and submit these documents
1131	1131	to the
1132	1132	Department.
1133	1133	Background check documents for all HSS provider personnel must be current,
1134	1134	within two (2) years
1135	1135	of submission date, and include:
1136	1136	(a) A current government issued photo Identification (ID) (e.g., driver's
1137	1137	license, state issued ID, or passport);
1138	1138	(b) Evidence
1139	1139	of each staff member's licensure, certification, or registration, as
1140	1140	applicable and as required by the job being performed;
1141	1141	(c) For non-licensed staff, evidence
1142	1142	of completion of an appropriate degree,
1143	1143	appropriate training program, or appropriate credentials (e.g., an academic
1144	1144	transcript or a copy
1145	1145	of degree);
1146	1146	(
1147	1147	d) Evidence of all required criminal background checks, and for all
1148	1148	staff members, application
1149	1149	of the criminal background check requirements
1150	1150	contained in the HSS Provider's HCA with the Department;
1151	1151	(e) Evidence
1152	1152	of quarterly checks that no individual is excluded from
1153	1153	participation in a federally funded health care program as listed on the
1154	1154	Department
1155	1155	of Health and Human Services' "List of Excluded
1156	1156	21 7414.6
1157	1157	7414.7
1158	1158	7414.8
1159	1159	7414.9
1160	1160	7414.10
1161	1161	7414.11
1162	1162	7414.12
1163	1163	7414.13
1164	1164	Individuals/Entities," the General Services Administration's "Excluded
1165	1165	Parties List System," or any similar succeeding governmental list; and
1166	1166	(f) Evidence
1167	1167	of completion of all communicable disease testing required by the
1168	1168	Department and District laws and regulations.
1169	1169	The HSS provider shall conduct each required screening for all staff at the
1170	1170	frequency required
1171	1171	by District law and regulations or by the Department, whichever
1172	1172	is most stringent.
1173	1173	The Department must clear each person employed by the HSS provider, including
1174	1174	subcontracted staff or any volunteers with direct contact with program individuals,
1175	1175	for fitness before beginning work or having contact with individuals.
1176	1176	The HSS provider shall ensure that any applicant for a compensated position and
1177	1177	candidates for unsupervised volunteer positions complete the required criminal
1178	1178	background screening before any such applicant or candidate may be offered a
1179	1179	compensated position or an unsupervised volunteer position with the HSS Provider.
1180	1180	The HSS provider must provide the Department the process
1181	1181	by which an applicant
1182	1182	for employment, including subcontractors or any volunteers with direct contact
1183	1183	with program individuals, shall declare any present or past events that might raise
1184	1184	liability or risk management concerns, such as malpractice actions, insurance
1185	1185	cancellations, criminal convictions, Medicare/Medicaid sanctions, and ethical
1186	1186	violations.
1187	1187	The HSS provider shall ensure all employees are not adversely affected
1188	1188	by alcohol,
1189	1189	illegal drugs, or legal drug use during work hours. The HSS provider shall have an
1190	1190	active drug-free workplace policy and shall utilize drug testing
1191	1191	to ensure that each
1192	1192	job applicant, employee, and unsupervised volunteer are not under the influence
1193	1193	of
1194	1194	drugs or alcohol while working with program individuals.
1195	1195	The HSS provider shall complete a suitability screening for each employee as
1196	1196	outlined in its HCA with the Department.
1197	1197	The HSS provider shall establish and adhere to policies and procedures responding
1198	1198	to individual grievances and incorporate this information into its HSS Program
1199	1199	Rules
1200	1200	as described in Section 18 of the Act.
1201	1201	The HSS provider shall establish uniform procedures for employees to file
1202	1202	grievances, in writing, to the provider (including requests for case manager
1203	1203	reassignments) and shall post these procedures in applicable paperwork,
1204	1204	administrative offices, and in the facilities used to provide services. The procedures
1205	1205	for filing grievances shall be a part
1206	1206	of the provider's employee handbook shall be
1207	1207	approved by the District.
1208	1208	22 7414.14
1209	1209	7414.15
1210	1210	7414.
1211	1211	16
1212	1212	7414.17
1213	1213	7414.18
1214	1214	7414.
1215	1215	19
1216	1216	7414.20
1217	1217	7414.21
1218	1218	The HSS provider shall have a written plan for staff development and
1219	1219	organizational onboarding, approved by the Department, which reflects the training
1220	1220	and performance improvement needs
1221	1221	of all employees working in that program.
1222	1222	The HSS provider shall establish and adhere
1223	1223	to policies and procedures for record
1224	1224	documentation, security, and confidentiality
1225	1225	of individual and family information;
1226	1226	clinical records retention, maintenance, purging and destruction; disclosure
1227	1227	of
1228	1228	individual and family information; and informed consent that comply with
1229	1229	applicable Federal and District laws and regulations.
1230	1230	The HSS provider shall have the necessary operational capacity to submit claims
1231	1231	for Medicaid-reimbursable HSS and invoices for locally-reimbursed PSH services,
1232	1232	document information on services provided, and track payments received. This
1233	1233	operational capacity shall include the ability
1234	1234	to:
1235	1235	(a) Verify eligibility for Medicaid and other third-party payers;
1236	1236	(b) Document HSS provided by Department-certified HSS provider staff and
1237	1237	sub-Provider;
1238	1238	(
1239	1239	c) Submit claims and invoices, and relevant documentation ofHSS on a timely
1240	1240	basis in compliance with applicable requirements
1241	1241	of the Department and
1242	1242	DHCF; and
1243	1243	(
1244	1244	d) Track payments for all provided HSS.
1245	1245	The HSS provider shall comply with requirements
1246	1246	of the District of Columbia
1247	1247	Language Access Act
1248	1248	of 2004, as amended, D.C. Official Code§ 2-1931, et seq.
1249	1249	The HSS provider shall also comply with requirements listed in Section 1557
1250	1250	of
1251	1251	the Patient Protection and Affordable Care Act, as amended, 42 U.S.C. § 18116(a).
1252	1252	The HSS provider shall comply with applicable provisions
1253	1253	of the Americans with
1254	1254	Disabilities Act
1255	1255	of 1990, 42 U.S.C. § 12101, et seq., in all business locations.
1256	1256	The HSS provider shall utilize a TeleTYpe (TTY) telecommunications line (or an
1257	1257	equivalent)
1258	1258	to enhance the HSS provider's ability to respond to service requests and
1259	1259	needs
1260	1260	of individuals and potential individuals. HSS provider staff shall be trained
1261	1261	in the use
1262	1262	of such communication devices as part of the annual language access
1263	1263	training.
1264	1264	The HSS provider shall establish and adhere to anti-discrimination policies and
1265	1265	procedures relative
1266	1266	to hiring, promotion, and provision of services to individuals
1267	1267	that comply with applicable Federal and District laws and regulations (Anti
1268	1268	Discrimination Policy).
1269	1269	23 7414.22
1270	1270	7414.23
1271	1271	7414.24
1272	1272	7414.25
1273	1273	The HSS provider shall have established by-laws or other legal documentation
1274	1274	regulating the conduct
1275	1275	of its internal financial affairs. This documentation shall
1276	1276	clearly identify the individual(s) that are legally responsible for making financial
1277	1277	decisions for the HSS provider and the scope
1278	1278	of such decision-making authority.
1279	1279	The HSS provider shall:
1280	1280	(a) Maintain an accounting system that conforms to generally accepted
1281	1281	accounting principles, provides for adequate internal controls, permits the
1282	1282	development
1283	1283	of an annual budget, an audit of all income received, and an
1284	1284	audit
1285	1285	of all expenditures disbursed by the HSS provider in the provision of
1286	1286	services;
1287	1287	(b) Have an internal process for the development
1288	1288	of interim and annual
1289	1289	financial statements that compares actual income and expenditures with
1290	1290	budgeted amounts, accounts receivable, and accounts payable information;
1291	1291	and
1292	1292	(c) Operate in accordance with an annual budget established by its governing
1293	1293	authority.
1294	1294	The HSS provider shall establish and adhere to policies and procedures governing
1295	1295	the retention, maintenance, purging and destruction
1296	1296	of its business records, that:
1297	1297	(a) Comply with applicable Federal and District laws and regulations;
1298	1298	(b) Require the HSS provider to maintain all business records pertaining
1299	1299	to
1300	1300	costs, payments received and made, and services provided to individuals for
1301	1301	a period
1302	1302	of ten (10) years or until all audits are completed, whichever is
1303	1303	longer; and
1304	1304	(c) Require the HSS provider to allow the Department, DHCF, the District's
1305	1305	Inspector General, HHS, the Comptroller General
1306	1306	of the United States, or
1307	1307	any
1308	1308	of their authorized representatives to review the HSS provider's
1309	1309	business records, including client clinical and financial records.
1310	1310	The HSS Provider, at its expense, shall:
1311	1311	(a) Obtain at least the minimum insurance coverage required by its HCA; and
1312	1312	(b) Make evidence of its insurance coverage available to the Department upon
1313	1313	request.
1314	1314	The HSS provider shall operate according to all applicable Federal and District laws
1315	1315	and regulations relating to fraud, waste, and abuse in health care, the provision
1316	1316	of
1317	1317	mental health services, and the Medicaid program. An HSS provider's failure to
1318	1318	report potential or suspected fraud, waste or abuse may result in sanctions,
1319	1319	24 7414.26
1320	1320	7414.27
1321	1321	7414.28
1322	1322	7415
1323	1323	7415.1
1324	1324	7415.2
1325	1325	cancellation
1326	1326	of contract, or exclusion from participation as an HSS provider. The
1327	1327	HSS provider shall:
1328	1328	(a) Cooperate and assist any District or Federal agency charged with the duty
1329	1329	of identifying, investigating, or prosecuting suspected fraud, waste, or
1330	1330	abuse;
1331	1331	(b) Provide the Department with regular access to the HSS provider's medical
1332	1332	and billing records, including electronic medical records, within twenty
1333	1333	four (24) hours
1334	1334	of a Departmental request, or immediately in the case of
1335	1335	emergency;
1336	1336	(
1337	1337	c) Be responsible for promptly reporting suspected fraud, waste, or abuse to
1338	1338	the Department, taking prompt corrective actions consistent with the terms
1339	1339	of any contract or subcontract with the Department, and cooperating with
1340	1340	DHCF or other governmental investigations; and
1341	1341	(
1342	1342	d) Ensure that none of its practitioners have been excluded from participation
1343	1343	as a Medicaid or Medicare provider.
1344	1344	If a practitioner is determined to be
1345	1345	excluded by CMS, the HSS provider shall notify the Department
1346	1346	immediately.
1347	1347	The HSS provider shall ensure that sufficient resources
1348	1348	(e.g., personnel, hardware,
1349	1349	or software) are available
1350	1350	to support the operations of computerized systems for
1351	1351	collection, analysis, and reporting
1352	1352	of information, along with claims submission.
1353	1353	The HSS provider shall have the capability to submit accurate claims, number
1354	1354	of
1355	1355	engagement with each individual on a monthly basis, and other submissions as
1356	1356	necessary directly
1357	1357	to the Department.
1358	1358	The HSS provider does not normally need an individual's detailed health
1359	1359	information, such
1360	1360	as diagnosis or specific services received, or full access to
1361	1361	medical records (particularly for behavioral health conditions or sensitive
1362	1362	information like HIV status). However, the HSS provider shall have a clearly
1363	1363	defined protocol to prevent inappropriate information sharing that might violate the
1364	1364	Health Insurance and Portability and Accountability Act
1365	1365	of 1996 (P.L. 104-191), as
1366	1366	amended (HIPAA) or Section
1367	1367	543 of the Public Health Service Act (P.L. 102-321).
1368	1368	HSS PROVIDER CERTIFICATION PROCESS
1369	1369	The Department shall use its HCA contracting process to certify each entity as an
1370	1370	HSS provider.
1371	1371	The Department shall utilize the certification process to thoroughly evaluate the
1372	1372	applicant's capacity
1373	1373	to provide high quality HSS in accordance with these
1374	1374	regulations and the needs
1375	1375	of the District's Continuum of Care.
1376	1376	25 7415.3
1377	1377	7415.4
1378	1378	7415.5
1379	1379	7415.6
1380	1380	7415.7
1381	1381	7415.8
1382	1382	No person or entity shall provide HSS unless certified by the Department.
1383	1383	Certification shall remain in effect until it expires,
1384	1384	is renewed, or is revoked.
1385	1385	Certification shall be considered terminated
1386	1386	if the HSS provider is no longer party
1387	1387	to a PSH HCA with the Department.
1388	1388	Certification
1389	1389	is not transferable to any other organization.
1390	1390	Nothing in this Chapter shall be interpreted to mean that certification
1391	1391	is a right or
1392	1392	an entitlement. Certification
1393	1393	as an HSS provider depends upon the Department's
1394	1394	assessment
1395	1395	of the need for additional HSS providers and availability of funds. An
1396	1396	entity that applies for certification during
1397	1397	an open application period as published
1398	1398	in the District
1399	1399	of Columbia Register may appeal the denial of certification under
1400	1400	this subsection by utilizing the procedures contained in 27 DCMR Ch.
1401	1401	3. The
1402	1402	Department shall not accept any applications for which a notice
1403	1403	of moratorium is
1404	1404	published in the District of Columbia Register.
1405	1405	The HSS provider shall notify the Department in writing thirty (30) calendar days
1406	1406	prior to implementing any
1407	1407	of the following operational changes, including all
1408	1408	aspects
1409	1409	of the operations materially affected by the changes:
1410	1410	(a) A proposed change in the name or ownership
1411	1411	of an HSS provider owned
1412	1412	by an individual, partnership, or association, or in the legal or beneficial
1413	1413	ownership
1414	1414	of ten percent (10%) or more of the stock of a corporation that
1415	1415	owns or operates the HSS provider;
1416	1416	(b) A change in affiliation or referral arrangements;
1417	1417	(c) A proposed change in the location
1418	1418	of the provider's headquarter location;
1419	1419	(
1420	1420	d) The proposed addition or deletion of services, which is anything that
1421	1421	would alter or disrupt services where the consumer would be impacted by
1422	1422	the change, or any change that would affect compliance with this Chapter;
1423	1423	(
1424	1424	e) A change in the required staff qualifications for employment;
1425	1425	(f) A change in the staff filling positions required by this Chapter;
1426	1426	(g) A proposed change
1427	1427	in organizational structure; or
1428	1428	(h) A proposed change in the population served.
1429	1429	26 7415.9
1430	1430	7415.10
1431	1431	7415.11
1432	1432	7416
1433	1433	7416.1
1434	1434	7416.2
1435	1435	The HSS provider shall forward
1436	1436	to the Department within thirty (30) calendar days
1437	1437	all inspection reports conducted by an oversight body and all corresponding
1438	1438	corrective actions taken regarding cited deficiencies.
1439	1439	The HSS provider shall immediately report
1440	1440	to the Department any criminal
1441	1441	allegations involving provider staff.
1442	1442	In order to maintain certification, a HSS provider shall:
1443	1443	(a) Participate in activities supporting the successful implementation of the
1444	1444	HSS program, including:
1445	1445	(1) Trainings to foster professional competency and development
1446	1446	of
1447	1447	best practices related to person-centered planning, chronic disease
1448	1448	self-management, and related topics;
1449	1449	(2) Continuous quality improvement tasks, monitoring and
1450	1450	performance reporting;
1451	1451	(3) District-wide initiatives
1452	1452	to support the exchange of health
1453	1453	information; and
1454	1454	(4) Evaluations required by CMS, DHCF or the Department;
1455	1455	(b) Maintain compliance with all requirements set forth in this Chapter; and
1456	1456	( c) Maintain compliance with all terms and conditions set forth in the HSS
1457	1457	provider's HCA with the Department and its DC Medicaid provider
1458	1458	agreement including all modifications,
1459	1459	as well as with all applicable federal
1460	1460	and District laws.
1461	1461	DENIAL OF CERTIFICATION OR DECERTIFICATION PROCESS
1462	1462	Only an organization with an executed PSH HCA with the Department may be
1463	1463	considered certified by the Department
1464	1464	to deliver HSS.
1465	1465	An organization that
1466	1466	is not awarded a PSH HCA with the Department, or is unable
1467	1467	to maintain a PSH HCA with the Department, and thus becomes decertified as an
1468	1468	HSS provider, may protest the Department's decision through the following steps:
1469	1469	(a) Submit written correspondence to the Department to convey its intent
1470	1470	to
1471	1471	protest the Department's decision, and
1472	1472	(b) Request that the District
1473	1473	of Columbia Contract Appeals Board hear the
1474	1474	case to determine whether the Department's decision should be upheld or
1475	1475	27 7417
1476	1476	7417.1
1477	1477	7417.2
1478	1478	7417.3
1479	1479	7417.4
1480	1480	7417.5
1481	1481	7418
1482	1482	7418.1
1483	1483	7418.2
1484	1484	7418.3
1485	1485	7419
1486	1486	7419.1
1487	1487	reversed, in accordance with Chapters
1488	1488	1, 2, 3, and 4 of Title 27 DCMR,
1489	1489	as amended.
1490	1490	HSS PROVIDER DISCONTINUATION OF SERVICES, PROVIDER
1491	1491	CLOSURES, AND CONTINUITY OF INDIVIDUAL CARE
1492	1492	An HSS provider shall provide written notification to the Department at least ninety
1493	1493	(90) calendar days prior to its impending closure, or immediately upon knowledge
1494	1494	of an impending closure. This notification shall include plans for continuity of care
1495	1495	and preservation
1496	1496	of individual records.
1497	1497	The Department shall review the continuity
1498	1498	of care plan and make
1499	1499	recommendations to the HSS provider as needed. The plan should include provision
1500	1500	for the referral and transfer
1501	1501	of individuals.
1502	1502	The HSS provider shall incorporate all Department recommendations necessary to
1503	1503	ensure a safe and orderly transfer
1504	1504	of care.
1505	1505	Closure
1506	1506	of an HSS provider does not absolve an HSS provider from its legal
1507	1507	responsibilities regarding the preservation and the storage
1508	1508	of individual records as
1509	1509	described
1510	1510	at§ 7414.15 of these regulations and all applicable Federal and District
1511	1511	laws and regulations. The HSS provider shall take all necessary and appropriate
1512	1512	measures to ensure individual records are preserved, maintained, and made
1513	1513	available to individuals upon request after closure
1514	1514	of a provider or discontinuation
1515	1515	of the applicable service.
1516	1516	An HSS provider shall be responsible for the execution
1517	1517	of its continuity of care plan
1518	1518	in coordination with the Department.
1519	1519	INDIVIDUAL PROTECTIONS
1520	1520	Medicaid individuals are entitled to Notice and Appeal rights pursuant to 29 DCMR
1521	1521	§ 9508 in cases
1522	1522	of intended adverse action, such as an action to deny, discontinue,
1523	1523	terminate, or change the manner or form
1524	1524	of Medicaid-funded HSS.
1525	1525	The HSS provider shall establish and adhere to a consumer rights policy that aligns
1526	1526	with Section 9
1527	1527	of the Act.
1528	1528	The HSS Provider shall establish and adhere to policies and procedures governing
1529	1529	the release
1530	1530	of information about individuals, which comply with applicable Federal
1531	1531	and District laws and regulations.
1532	1532	QUALITY ASSURANCE AND IMPROVEMENT
1533	1533	The HSS provider shall submit to the Department a quality improvement plan that
1534	1534	describes how the provider will ensure and measure for each individual:
1535	1535	28 7419.2
1536	1536	7419.3
1537	1537	7420
1538	1538	7420.1
1539	1539	7420.2
1540	1540	7420.3
1541	1541	7420.4
1542	1542	(a) Timely access to and availability of services; and
1543	1543	(b) Adequacy, appropriateness, and quality of care, including treatment and
1544	1544	prevention
1545	1545	of acute and chronic conditions.
1546	1546	The HSS provider's quality improvement plan shall describe its protocols
1547	1547	to:
1548	1548	(a) Closely monitor individuals with severe housing stability barriers and
1549	1549	children and youth within
1550	1550	an individual's household with complex service
1551	1551	needs;
1552	1552	(b) Coordinate individual services with behavioral health providers; and
1553	1553	(
1554	1554	c) Collect and respond to individual satisfaction with services delivered by the
1555	1555	Provider.
1556	1556	The HSS provider's quality improvement plan shall be approved by the Department
1557	1557	annually.
1558	1558	REIMBURSEMENT
1559	1559	Effective April 1, 2022, the District shall establish a per member per month
1560	1560	(PMPM) rate to reimburse HSS providers for the provision
1561	1561	of HSS delivered to
1562	1562	individuals enrolled in the DC Medicaid program using a PMPM payment
1563	1563	structure. The PMPM rate shall be determined in accordance with 29 DCMR §
1564	1564	103.3.
1565	1565	The HSS PMPM reimbursement rate shall be seven hundred and fifty-five dollars
1566	1566	and twenty-one cents ($755.21). Upon the launch
1567	1567	of the HSS benefit, this rate, and
1568	1568	any amendments
1569	1569	to this rate, will be published on the DHCF website at www.dc
1570	1570	medicaid.com and in accordance with 29 DCMR § 988.4.
1571	1571	The Department shall reimburse HSS providers, using a PMPM payment structure,
1572	1572	for the provision
1573	1573	of PSH services to individuals that are not eligible for enrollment
1574	1574	in the District Medicaid HSS program, or that temporarily lose their Medicaid
1575	1575	enrollment status. The PMPM rate paid by the Department shall equal the rate
1576	1576	described above at §7420.2 and in accordance with 29 DCMR § 988.4.
1577	1577	The Department shall reimburse HSS providers for the provision
1578	1578	of adjunct services
1579	1579	that facilitate the provision
1580	1580	of HSS and promote the housing stability of adult
1581	1581	individuals on a monthly basis. The reimbursement rates for each type
1582	1582	of service
1583	1583	are detailed below or in the Department's HCA with the HSS provider:
1584	1584	(a) Services provided
1585	1585	to minors in an adult individual's household, at a rate of
1586	1586	four hundred dollars ($400) per household, per month;
1587	1587	29 7420.5
1588	1588	7420.6
1589	1589	7420.7
1590	1590	7420.8
1591	1591	7420.9
1592	1592	7420.10
1593	1593	7420. 11
1594	1594	(b) Utility assistance;
1595	1595	(c) Financial assistance; and
1596	1596	(
1597	1597	d) Staff onboarding.
1598	1598	To be eligible for a PMPM payment for PSH services for an individual receiving
1599	1599	Housing Navigation Services, a PSH provider shall deliver any service listed at §
1600	1600	7403
1601	1601	of this Chapter at a minimum frequency of once a week within the month. At
1602	1602	least two (2)
1603	1603	of these services shall be delivered face-to-face with the client. The
1604	1604	other contacts may be made by telephone, email, text, or another electronic format.
1605	1605	To be eligible for a PMPM payment for PSH services for an individual receiving
1606	1606	Housing Stabilization Services, a PSH provider shall deliver any service listed at
1607	1607	§ 7404
1608	1608	of this Chapter at a minimum frequency of twice a month. At least one of
1609	1609	these services shall be delivered face-to-face with the client. The other contact may
1610	1610	be made by telephone, email, text, or another electronic format.
1611	1611	To receive a PMPM payment for PSH services delivered to minors in the eligible
1612	1612	individual's household, the HSS provider shall provide services at the scope and
1613	1613	frequency described in the HSS provider's HCA with the Department.
1614	1614	For individuals not eligible for reimbursement through the District's Medicaid
1615	1615	program, each HSS Provider shall submit a monthly invoice to the Department for
1616	1616	reimbursement within thirty (30) days
1617	1617	of the date of service or of the date a
1618	1618	Medicaid claim is denied for the same date
1619	1619	of service.
1620	1620	Reimbursement to
1621	1621	an HSS provider for the provision of HSS to individuals
1622	1622	participating in the DC Medicaid HSS benefit shall be in accordance with Chapter
1623	1623	103 (Medicaid Reimbursement for Housing Supportive Services), to Title 29
1624	1624	(Public Welfare),
1625	1625	of the District of Columbia Municipal Regulations (DCMR).
1626	1626	An HSS provider's submission of an invoice to the Department for PSH delivered
1627	1627	to an adult individual will serve as the HSS provider's attestation that avenues for
1628	1628	Medicaid reimbursement for the services have been exhausted, and that the HSS
1629	1629	provider has followed all necessary procedures and policies for supporting the
1630	1630	individual's initial and continued enrollment in the District's Medicaid program.
1631	1631	An HSS provider shall not submit an invoice to the Department for a Medicaid
1632	1632	claim that
1633	1633	is not submitted or denied because the submission was unacceptable or
1634	1634	untimely.
1635	1635	30 7420.12
1636	1636	7420.
1637	1637	13
1638	1638	7421
1639	1639	7421.1
1640	1640	An HSS provider shall be eligible
1641	1641	to receive one PMPM rate for HSS services
1642	1642	provided
1643	1643	to an adult individual, and, if applicable, one additional PMPM rate for
1644	1644	PSH services provided to minors within the adult individual's household.
1645	1645	Any claim submitted to Medicaid for reimbursement or invoice submitted to DHS
1646	1646	for reimbursement for program services shall be supported by written
1647	1647	documentation in the individual's record
1648	1648	in the Department's case note system,
1649	1649	according
1650	1650	to the standards described in this Chapter.
1651	1651	NON-REIMBURSABLE SERVICES
1652	1652	The following services are not covered as HSS:
1653	1653	(a) Room and board residential costs;
1654	1654	(b) Inpatient hospital services, including hospital, nursing facility, intermediate
1655	1655	care facility for individuals with intellectual disabilities, and institutions for
1656	1656	mental diseases;
1657	1657	(
1658	1658	c) Prescription drug costs;
1659	1659	(
1660	1660	d) Transportation services;
1661	1661	(
1662	1662	e) Financial deposits:
1663	1663	(t) Food;
1664	1664	(g) Furnishings;
1665	1665	(h) Utilities;
1666	1666	(i) Moving expenses;
1667	1667	U) Rent;
1668	1668	(k) Educational, vocational, and job training services;
1669	1669	(1) Services rendered by parents or other family members;
1670	1670	(m) Social or recreational services;
1671	1671	(n) Services that are not provided and documented in accordance with these
1672	1672	certification standards; and
1673	1673	( o) Services furnished to persons other than the consumer when those services
1674	1674	are not directed primarily
1675	1675	to the well-being and benefit of the individual.
1676	1676	31 7499
1677	1677	7499.1
1678	1678	7499.2
1679	1679	DEFINITIONS
1680	1680	The terms in this Chapter shall have the definitions set forth in Section 2 of the Act.
1681	1681	In addition, the following terms in this Chapter shall have the meaning ascribed:
1682	1682	Act-the Homeless Services Reform Act of 2005, effective October 22, 2005 (D.C.
1683	1683	Law 16-35; D.C. Official Code§ 4-751.01, et seq.),
1684	1684	as amended.
1685	1685	Assessment - a clinical evaluation performed by a qualified group or individual of
1686	1686	the consumer's physical, mental, behavioral, social, and emotional health.
1687	1687	It considers the consumer's s perception
1688	1688	of self and ability to function
1689	1689	socially at home and in the community, and relevant historical data
1690	1690	as it
1691	1691	impacts the quality
1692	1692	of the consumer's life.
1693	1693	Case management - a set of services and interventions focused on assisting HSS
1694	1694	individuals to obtain and retain permanent housing, move toward the
1695	1695	greatest degree
1696	1696	of self-sufficiency, and are based on the consumer's goals
1697	1697	and preferences outlined in their
1698	1698	ISP. These services include coordination
1699	1699	of and assisting consumers to access financial assistance, tenancy support,
1700	1700	social services, health care services, and other resources available in the
1701	1701	community.
1702	1702	Case note - a chronological record of the delivery of services and support to head
1703	1703	of households and their dependent and/or minor children. Case notes also
1704	1704	provide the necessary documentation to support claims
1705	1705	to funding sources,
1706	1706	and provide a single place for case managers, social workers, supervisors
1707	1707	and colleagues, state and federal auditors and others with appropriate access
1708	1708	to read about recent case activity.
1709	1709	Certification - the written authorization from the Department rendering an entity
1710	1710	eligible to provide HSS.
1711	1711	Certification standards - the mm1mum requirements established by the
1712	1712	Department in this Chapter that a provider shall satisfy
1713	1713	to obtain and
1714	1714	maintain certification
1715	1715	to provide HSS and receive reimbursement from the
1716	1716	District for HSS.
1717	1717	Collateral contact-an individual involved in the individual's care. This individual
1718	1718	may be a family member, guardian, healthcare professional or person ( e.g
1719	1719	.,
1720	1720	landlord/property manager, lawyer) who is a knowledgeable source of
1721	1721	information about the individual's situation and serves to support or
1722	1722	corroborate information provided by the individual. The individual
1723	1723	contributes a direct and
1724	1724	an exclusive benefit for the individual.
1725	1725	32 Consumer - an individual client as defined in section 2(7) of the Act.
1726	1726	Coordinated Assessment and Housing Placement (CAHP) System - the
1727	1727	District's "centralized or coordinated assessment system"
1728	1728	as defined in
1729	1729	section 2(6A)
1730	1730	of the Act, also referred to as coordinated entry or coordinated
1731	1731	intake, and further defined in publicly available CARP governance
1732	1732	guidance.
1733	1733	Data Assessment Plan (DAP) - a standard used to define a comprehensive case
1734	1734	note in the Department's web-based case note system. The term 'Data'
1735	1735	is
1736	1736	defined as the subjective and objective information about the individual's
1737	1737	goals and progress made toward them. The term 'Assessment'
1738	1738	is defined as
1739	1739	a written note completed by the individual's case manager that describes the
1740	1740	case manager's observations about the individual's interactions with family
1741	1741	members, the individual's motivation to move toward their goals and the
1742	1742	tone, and affect and demeanor
1743	1743	of the individual, along with how the
1744	1744	individual is maintaining their housing unit. The term 'Plan'
1745	1745	is defined as
1746	1746	the measurable objectives the individual will be working on until the next
1747	1747	visit. The Plan also notes when the next engagement with the individual
1748	1748	is
1749	1749	scheduled.
1750	1750	Department - the District of Columbia Department of Human Services or any
1751	1751	successor organizational unit (in whole or in part).
1752	1752	Department of Health Care Finance - the District of Columbia state Medicaid
1753	1753	agency.
1754	1754	Director - the Director of the Department.
1755	1755	Disability- as defined at 42 U.S.C. § 416(i).
1756	1756	Disabling condition - an injury, substance use disorder, mental health condition,
1757	1757	or illness, as diagnosed by a qualified health professional, that
1758	1758	is expected
1759	1759	to cause an extended or long-term incapacitation but does not meet the
1760	1760	definition
1761	1761	of disability in, as defined at 42 U.S.C. § 416(i).
1762	1762	Governing authority - the designated individuals or body legally responsible for
1763	1763	conducting the affairs
1764	1764	of the HSS Provider.
1765	1765	Grievance - a description by any individual of his or her dissatisfaction with an
1766	1766	HSS provider, including the denial or abuse
1767	1767	of any consumer right or
1768	1768	protection provided by applicable Federal and District laws and regulations.
1769	1769	Homeless Management Information System - the District's information
1770	1770	technology system used
1771	1771	to collect client-level data and data on the provision
1772	1772	33 of housing and services to homeless individuals and families and persons at
1773	1773	risk
1774	1774	of homelessness.
1775	1775	Homeless Outreach Provider Team -an organization contracted by the
1776	1776	Department
1777	1777	to engage individuals who are living on the streets and are
1778	1778	experiencing homelessness. Outreach efforts connect vulnerable
1779	1779	individuals to housing resources within the Coordinated Entry System
1780	1780	Household -a home dwelling and its occupants.
1781	1781	Housing navigation -using a Housing First approach, Housing Navigation
1782	1782	assistance offered by the Provider is designed
1783	1783	to identify and secure housing
1784	1784	for consumers
1785	1785	as quickly as possible, by implementing activities such as:
1786	1786	active recruitment and retaining of landlords and housing managers willing
1787	1787	to rent
1788	1788	to consumers (who may otherwise fail to pass typical tenant
1789	1789	screening criteria); housing unit search and identification; helping
1790	1790	consumers gather documents needed for housing placement; completing
1791	1791	the housing and subsidy application process; and moving and securing basic
1792	1792	housing needs. The Housing Navigation assistance offered by the PSHP
1793	1793	Provider to all consumers, needs to be consistent with the consumer's needs
1794	1794	and preferences (within the limits
1795	1795	of their income combined with available
1796	1796	subsidy), taking into consideration safety and access
1797	1797	to transportation,
1798	1798	connection to health care, treatment, school, daycare and support systems,
1799	1799	and employment opportunities.
1800	1800	Housing stabilization -services and actions designed to help households at risk
1801	1801	of becoming homeless to keep housing.
1802	1802	Housing Supportive Services -housing-related activities and services that support
1803	1803	a person's ability to prepare for and transition
1804	1804	to housing, and services that
1805	1805	support a person in continuing successful tenancy in their housing unit.
1806	1806	Housing unit - a single room occupancy room/facility, individual apartment,
1807	1807	townhome, or single-family home utilized to house consumers in HSS.
1808	1808	Housing units for families have separate cooking facilities and other basic
1809	1809	necessities
1810	1810	to enable families to prepare and consume meals; bathroom
1811	1811	facilities for the use
1812	1812	of the family; and separate sleeping quarters for adults
1813	1813	and minor children in accordance with the occupancy standards
1814	1814	of Title 14
1815	1815	of the DCMR. Housing units can be project-based or tenant-based.
1816	1816	HSS Provider -the individual, organization, or corporation, public or private, that
1817	1817	provides HSS services, meets the qualifications set forth in this Chapter and
1818	1818	seeks reimbursement for providing those services under the Medicaid
1819	1819	program. An HSS provider
1820	1820	is a provider as defined under Section 2(30) of
1821	1821	the Act and an HSS agency as defined at 29 DCMR 10399.
1822	1822	34 Human Care Agreement - a written agreement for the procurement of education
1823	1823	or special education, health, human, or social services pursuant
1824	1824	to D.C.
1825	1825	Official Code § 2-354.06, to be provided directly to persons who are
1826	1826	disabled, disadvantaged, displaced, elderly, indigent, mentally or physically
1827	1827	ill, unemployed, or minors in the custody
1828	1828	of the District of Columbia.
1829	1829	Individual - a person eligible to receive HSS as set forth in this Chapter.
1830	1830	Individual Service Plan - a written agreement between the individual and the HSS
1831	1831	provider describing the results
1832	1832	of the person-centered planning process
1833	1833	addressing the strengths, preferences, needs and dreams
1834	1834	as described by the
1835	1835	person. The plan consists
1836	1836	of time-specific goals and objectives designed to
1837	1837	promote self-sufficiency and attainment
1838	1838	of permanent housing. These goals
1839	1839	and objectives are based on the consumer's assessed needs, desires,
1840	1840	strengths, resources, and limitations.
1841	1841	Key personnel - the essential staff required to implement and execute the scope of
1842	1842	work in the HSS Provider's Human Care Agreement.
1843	1843	Linkage -when a Provider connects or joins a consumer with a needed service or
1844	1844	support. This could include, but
1845	1845	is not limited to, communicating on behalf
1846	1846	of the consumer to the service, providing the consumer contact information
1847	1847	or completing needed applications or paperwork. The Provider must first
1848	1848	ensure the service or support
1849	1849	is current and viable.
1850	1850	Medicaid - the medical assistance program approved by federal Centers for
1851	1851	Medicare and Medicaid Services and administered by DHCF, which
1852	1852	enables the District
1853	1853	to receive federal financial assistance for its medical
1854	1854	assistance program and other purposes as permitted by law.
1855	1855	Organizational onboarding - the mechanism through which new employees
1856	1856	acquire the necessary knowledge, skills, and behaviors to become effective
1857	1857	performers. It begins with recruitment and includes a series
1858	1858	of events, one
1859	1859	of which is employee orientation, which helps new employees understand
1860	1860	performance expectations and contribute
1861	1861	to the success of the organization.
1862	1862	Outreach and engagement - describes the processes used to find/locate a
1863	1863	consumer, establish contact with them ( outreach) and build a long-lasting,
1864	1864	trusting connection with the individual services Provider ( engagement).
1865	1865	Outreach and engagement practices are targeted, proactive, and client
1866	1866	centered, with particular attention given to finding and engaging with
1867	1867	persons in crisis, who may be initially reluctant to accept assistance.
1868	1868	Quality control- an HSS Provider's internal system for monitoring and improving
1869	1869	delivery
1870	1870	of services and internal operations.
1871	1871	35 Self-sufficiency - the ability to provide for one's own social and economic needs
1872	1872	with little
1873	1873	to no assistance from others.
1874	1874	Supplemental Nutrition Assistance Program - formerly known as the Food
1875	1875	Stamp program, SNAP provides food-purchasing assistance to District
1876	1876	residents with low-or no-income.
1877	1877	Supportive Services - an array of medical, behavioral health, substance use,
1878	1878	educational, social services, employment, life skills, and financial services
1879	1879	aimed at enabling housing placement, housing stability, health, wellness,
1880	1880	community integration, self-sufficiency, and the improved quality
1881	1881	of life of
1882	1882	an individual.
1883	1883	Chapter 25, SHELTER AND SUPPORTIVE HOUSING FOR INDIVIDUALS AND
1884	1884	FAMILIES,
1885	1885	of Title 29 DCMR, is amended as follows:
1886	1886	A new section 2574, REIMBURSEMENT FOR PSH SUPPORTIVE SERVICES,
1887	1887	is added to
1888	1888	read as follows:
1889	1889	2574
1890	1890	2574.1
1891	1891	2574.2
1892	1892	2574.3
1893	1893	REIMBURSEMENT FOR PSH SUPPORTIVE SERVICES
1894	1894	The Department shall reimburse PSH providers, using per member per month
1895	1895	(PMPM) rate structure, for the provision
1896	1896	of PSH services to adult participants that
1897	1897	are not eligible for enrollment in the District's Medicaid Housing Supportive
1898	1898	Services (HSS) program, or that temporarily lose their DC Medicaid enrollment
1899	1899	status. The PMPM rate paid by the Department shall equal the rate described at 29
1900	1900	DCMR § 7420.2.
1901	1901	The Department shall also reimburse PSH providers for the provision
1902	1902	of adjunct
1903	1903	services that facilitate the provision
1904	1904	of PSH and promote the housing stability of
1905	1905	adult participants on a monthly basis. The reimbursement rates for each type of
1906	1906	service are detailed below or in the Department's HCA with the PSH provider:
1907	1907	(a) Services provided to minors in an adult participant's household, at a rate of
1908	1908	$400.00 per household, per month;
1909	1909	(b) Utility assistance;
1910	1910	(
1911	1911	c) Financial assistance; and
1912	1912	(
1913	1913	d) Staff onboarding.
1914	1914	In order to be eligible for a PMPM payment for PSH services, a PSH provider shall
1915	1915	deliver a minimum
1916	1916	of two (2) PSH services to an eligible adult client within a
1917	1917	month.
1918	1918	36 2574.4
1919	1919	2574.5 To receive a monthly household payment for PSH services delivered to minors in
1920	1920	the adult individual's household, the HSS provider shall provide services at the
1921	1921	scope and frequency described in the HSS provider's HCA with the Department.
1922	1922	The following services are not covered
1923	1923	as PSH services:
1924	1924	(a) Room and board residential costs;
1925	1925	(b) Inpatient hospital services, including hospital, nursing facility, intermediate
1926	1926	care facility for individuals with intellectual disabilities, and institutions for
1927	1927	mental diseases;
1928	1928	(
1929	1929	c) Prescription drug costs;
1930	1930	(
1931	1931	d) Transportation services;
1932	1932	(e) Educational, vocational, and job training services;
1933	1933	(f) Services rendered by parents or other family members;
1934	1934	(g) Social or recreational services;
1935	1935	(h) Services that are not provided and documented in accordance with these
1936	1936	certification standards; and
1937	1937	(i) Services furnished
1938	1938	to persons other than the client or client's household
1939	1939	members when those services are not directed primarily
1940	1940	to the well-being
1941	1941	and benefit
1942	1942	of the individual.
1943	1943	37