MURIEL BOWSER
MAYOR
November 14, 2023
The Honorable Phil Mendelson
Chairman
Council
of the District of Columbia
1350 Pennsylvania Avenue, NW, Suite 504
Washington,
DC 20004
Dear Chainnan Mendelson:
Enclosed for consideration and approval
by the Council of the District of Columbia, pursuant to section
31 of the Homeless Services Reform Act of 2005, effective October 22, 2005 (D.C. Law 16-35; D.C.
Official Code
§ 4-756.02), is the "Housing Supportive Services and Provider Certification Standards
Approval Resolution
of 2023 ".
The resolution would approve rules that establish requirements and procedures for the District to
administer the new l 915(i) State Plan Home and Community-Based Services Housing Supportive
Services ("HSS") benefit and conditions
of participation for entities delivering these services. HSS are
services that focus on helping District Medicaid beneficiaries who are homeless or at risk ofhomtdessness
find and maintain permanent housing in the community, build independent living and tenancy skills, and
connect them
to community resources. The benefit is targeted to people with disabilities or complex
health needs, who often experience significant barriers to accessing care and housing.
The Department operates the new HSS benefit in conjunction with the Department
of Health Care
Finance ("DHCF")
in accordance with a Fiscal Year 2022 Memorandum of Understanding between DHS
and DHCF. DHCF has adopted corresponding rules
in Chapter 103 (Medicaid Reimbursement for
Housing Supportive Services)
of Title 29 (Public Welfare) of the DCMR. These mies establish HSS
eligibility, enrollment procedures, provider requirements, provider ce1iification procedures, and rates for
provider reimbursement under the District's Medicaid program. ln addition, for the purpose
of
maintaining uniform housing-related supportive services standards between HSS and Permanent
Supportive Housing ("PSH") programs, these rules also establish reimbursement rates for PSH services in
Chapter 25.
I urge the Council to take prompt and favorable action on this proposed resolution. 1
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Chairman Phil Mendelson
at the request
of the Mayor
A PROPOSED RESOLUTION
IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
To approve proposed final rules to implement the Housing Supportive Services Benefit and
Provider Certification Standards.
RESOLVED, BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this
resolution may be cited as the "Housing Supportive Services and Provider Certification
Standards Approval Resolution
of 2023".
Sec.
2. Pursuant to section 31 of the Homeless Services Reform Act of 2005, effective
October 21, 2005 (D.C. Law 16-35; D.C. Official
Code§ 4-756.02), the Council approves the
proposed final rules
of the Director of the Department of Human Services to adopt a new
Chapter 74 (Housing Supportive Services and Provider Certification Standards) and amend
Chapter
25 (Shelter and Supportive Housing for Individuals and Families) of Title 29 (Public
Welfare)
of the District of Columbia Municipal Regulations, regarding the implementation of the
Housing Supportive Services and Provider Certification Standards benefit, which were
transmitted to the Council by the Mayor on
_____ _
Sec.
3. Transmittal.
The Council shall transmit a copy
of this resolution, upon its adoption, to the Mayor, the
Director
of the Department of Human Services, and the Administrator of the Office of
Documents and Administrative Issuances.
1 33 Sec. 4. Fiscal impact statement.
34 The Council adopts the fiscal impact statement in the committee report as the fiscal
35 impact statement required by section 4a of the General Legislative Procedures Act of 1975,
36 approved October 16, 2006 (120 Stat. 2038; D.C. Official Code§ 1-301.47a).
37 Sec. 5. Effective date.
38 This resolution shall take effect immediately.
2 DEPARTMENT OF HUMAN SERVICES
NOTICE OF FINAL RULEMAKING
(as submitted to the Council of the District of Columbia for its review and approval
pursuant
to section 31 of the Homeless Services Reform Act of 2005,
effective October
22, 2005 (D.C. Law 16-35; D.C. Official Code§ 4-756.02))
The Director of the Department of Human Services ("Director"), pursuant to the authority set forth
in Section
31 of the Homeless Services Reform Act of 2005, effective October 22, 2005 (D.C.
Law 16-35; D.C. Official Code§ 4-756.02), and Mayor's Order 2006-20, dated February 13, 2006,
hereby gives notice
of her adoption of the following new Chapter 74 (Housing Supportive Services
and Provider Certification Standards) and the following amendments to Chapter
25 (Shelter and
Supportive Housing for Individuals and Families)
of Title 29 (Public Welfare) of the District of
Columbia Municipal Regulations ("DCMR").
These rules establish standards
to administer the new 1915(i) State Plan Home and Community
Based Services Housing Supportive Services ("HSS") benefit and conditions
of participation for
entities delivering these services. HSS are services that focus on helping District Medicaid
beneficiaries who are homeless or at risk
of homelessness find and maintain permanent housing in
the community, build independent living and tenancy skills, and connect them to community
resources. The benefit is targeted to people with disabilities or complex health needs, who often
experience significant barriers to accessing care and housing.
The Department operates the new HSS benefit in conjunction with the Department
of Health Care
Finance ("DHCF") in accordance with a Fiscal Year 2022 Memorandum
of Understanding
between DHS and DHCF. DHCF has adopted corresponding rules in Chapter
103 (Medicaid
Reimbursement for Housing Supportive Services)
of Title 29 (Public Welfare) of the DCMR.
These rules establish HSS eligibility, enrollment procedures, provider requirements, provider
certification procedures, and rates for provider reimbursement under the District's Medicaid
program. In addition, for the purpose
of maintaining uniform housing-related supportive services
standards between HSS and Permanent Supportive Housing ("PSH") programs, these rules also
establish reimbursement rates for PSH services in Chapter 25.
An initial Notice
of Emergency and Proposed Rulemaking was published in the District of
Columbia Register on June 17, 2022, at 69 DCR 7181. A second Notice of Emergency Rulemaking
was subsequently published in the
District of Columbia Register on August 5, 2022, at 69 DCR
10060. A third Notice
of Emergency Rulemaking was adopted on October 14, 2022, went into
effect at that time, and remained in effect until February
11, 2023. The third Notice of Emergency
Rulemaking was published in the
District of Columbia Register on June 2, 2023, at 70 DCMR
7991. A fourth Notice
of Emergency Rulemaking and second Notice of Proposed Rulemaking was
published in the
District of Columbia Register on June 2, 2023, at 70 DCMR 8029. These rules
are identical
to the second proposed rulemaking, in response to which the District received no
public comments.
Further, in accordance with section
31 of the HSRA (D.C. Official Code§ 4-756.02), the proposed
final rules were submitted to the Council for a forty-five (45) day period
of review and were deemed approved on September_, 2023, pursuant to PR 25-_. On September_, 2023, the
Director
of the Department adopted these rules as final, and the rules shall become effective upon
publication
of this notice in the District of Columbia Register.
A new Chapter 74, HOUSING SUPPORTIVE SERVICES AND PROVIDER
CERTIFICATION ST AND ARDS,
of Title 29 DCMR, is added to read as follows:
7400
7400.1
7400.2
7400.3
7400.4
7400.5
7400.6
CHAPTER 74 HOUSING SUPPORTIVE SERVICES AND PROVIDER
CERTIFICATION ST AND ARDS
GENERAL PROVISIONS
The mission of the Department of Human Services (Department) is to empower
every District resident to reach their full potential by providing meaningful
connections to work opportunities, economic assistance and supportive services.
The Economic Security Administration
is the administration within the Department
that
is responsible for making eligibility determinations for federally and locally
funded public assistance programs in the District, including Medicaid, the
Supplemental Nutrition Assistance Program, and the Temporary Assistance for
Needy Families program. The Family Services Administration is the administration
within the Department that
is responsible for providing homeless services such as
shelter and homelessness prevention, to meet the needs of vulnerable adults and
families to help reduce risk and promote self-sufficiency.
The purpose
of this Chapter is to establish standards for the Housing Supportive
Services (HSS) benefit, including eligibility criteria, service standards, HSS
provider certification requirements, and which services shall be reimbursed through
Medicaid.
HSS are Medicaid-reimbursable activities that include a range
of flexible housing
related services and supports for adults at risk
of or experiencing chronic
homelessness and who have a disability or disabling condition that interferes with
or limits their capacity to maintain housing stability.
Permanent supportive housing (PSH) programs provide services similar to HSS but
are funded through the District's local budget for adults who are ineligible for
Medicaid enrollment. PSH services are also available to children and youth
residing in the home
of an adult who is receiving the HSS benefit.
As provided in this Chapter, an individual is eligible to receive services through the
HSS benefit
if they are eligible for the District's PSH program and enrolled in the
District's Medicaid program.
An HSS Provider may also provide PSH services. Services and supports that do not
qualify for HSS Medicaid reimbursement
as described in this Chapter but that
2 7400.7
7400.8
7401
7401.1
7401.2
7401.3
qualify
as PSH services will generally be eligible for reimbursement by the
Department through the PSH program, pursuant
to the PSH program rules.
The HSS benefit described in this Chapter has been designed to comply with
requirements established in federal home and community-based services
regulations (
42 CFR § 441. 710) and clarified by informational bulletins published
by the U.S. Department
of Health and Human Services, Centers for Medicare and
Medicaid Services (CMS), Center for Medicaid and CHIP Services.
Each Department-certified HSS provider shall meet and adhere
to the terms and
conditions
of its PSH Human Care Agreement (HCA) with the Department.
ELIGIBLE CONSUMERS
To be determined eligible for HSS, an individual shall:
(a) Be eighteen (18) years
of age or older;
(b) Be enrolled in Medicaid or meet the criteria described
at§ 7401.4;
(c) Be a resident
of the District as defined in section 2(32) of the Homeless
Services Reform Act
of 2005, as amended (D.C. Official Code §4-
751.01(32));
(d) Have a documented disability or disabling condition;
( e) Be experiencing housing instability as evidenced by one
of the following
risk factors:
(1) Chronic homelessness;
(2) At risk
of chronic homelessness; or
(3) History
of chronic homelessness and for whom providing HSS will
prevent a return
to homelessness; and
(t) Be determined eligible for PSH services through the District's Coordinated
Assessment Housing Placement system.
An individual who
is seventeen (17) years old or younger who lives in the
household
of an adult participating in the HSS benefit may qualify for PSH
services.
An HSS Provider shall not receive Medicaid reimbursement under this Chapter for
supportive services provided to an individual who does not meet the eligibility
requirements set forth in subsection 7401.1.
3 7401.4
7402
7402.1
7402.2
7402.3
7402.4
7402.5
For individuals seeking enrollment in the District's Medicaid program or whose
Medicaid coverage has lapsed:
(a) There is an eligibility grace period
of ninety (90) calendar days from the
date
of first service for new enrollees, or from the date of eligibility
expiration for enrollees who have a lapse in Medicaid coverage, until the
date
an eligibility or renewal determination is made;
(b)
If the individual appeals a denial of Medicaid eligibility or renewal, the
Director
of the Department (Director) may extend the ninety (90) calendar
day eligibility grace period until the appeal has been exhausted. The ninety
(90) calendar day eligibility grace period may also be extended
at the
discretion
of the Director for other good cause shown;
(
c) Upon expiration of the eligibility grace period, HSS provided to the
individual are
no longer reimbursable by Medicaid; and
(
d) Nothing in this section alters the District's timely filing requirements for
claim submissions described at 29 DCMR § 900.
HSS -GENERAL
HSS are wrap-around services rendered by Department-certified HSS Providers to
eligible individuals who require home and community-based services to assist with
achieving and maintaining housing.
HSS shall assist an individual in mitigating their barriers
to securing and
maintaining housing and support the individual in achieving their housing-related
goals.
HSS are activities that:
(a) Support an individual's preparation to secure housing, known as Housing
Navigation; and
(b) Assist with an individual's tenancy m housing, known
as Housing
Stabilization.
HSS shall be undertaken as a partnership between the HSS Provider, the individual,
and, as appropriate, other providers and agencies.
HSS providers are entities certified in compliance with the standards set forth in
this Chapter.
4 7402.6
7402.7
7402.8
7402.9
7403
7403.1
7403.2
As set forth at 42 CFR § 441.700 to § 441.745, an individual participating or
seeking enrollment in the HSS benefit shall receive a conflict-free assessment
of
their functional needs and service plan development. The person that completes the
assessment and develops the service plan with the individual shall not be employed
by the same organization that will deliver HSS to the individual.
As further set forth at 42 CFR § 441.725(a)(6), individuals that receive HSS have
the right to choose their HSS provider.
HSS coverage limitations are set forth in § 7421. Coverage for any HSS
is
contingent on whether all the following criteria are met:
(a) The service shall be delivered to or on behalf
of a person that meets HSS
eligibility criteria for HHS,
as described at§ 7401;
(b) The service shall be delivered through a Department-certified HSS
provider;
(
c) The service shall be rendered pursuant to the applicable service-specific
standards set forth in this Chapter; and
(
d) The service shall be delivered in accordance with an approved individual
service plan.
The service-specific standards described in this Chapter apply to the HSS offered
by each HSS provider and reimbursed by the District in accordance with this
Chapter.
HOUSING NAVIGATION SERVICES
Housing Navigation Services help an individual plan for, find, and move to housing
of their own in the community.
Housing Navigation Services include assisting the individual to:
(a) Obtain key documents needed for the housing application process;
(b) Complete the housing application process, including following up with key
partners (such
as landlords and government agencies) to ensure receipt and
processing
of documents;
(
c) Complete the housing search process, including helping the individual
identify neighborhood and unit needs and preferences, potential barriers (to
avoid applying for units for which they will be screened out), helping
identify possible units, and assisting the individual to view units
as needed;
5 7404
7404.1
7404.2
(d) Identify resources to cover expenses such as security deposit, moving costs,
furnishings, adaptive aids, environmental modifications, moving costs and
other one-time expenses not covered by Medicaid;
(
e) Coordinate a unit inspection with the DC Housing Authority and the
housing provider or landlord to ensure a unit
is safe and ready for habitation;
( t) Arrange for and support the details
of the move;
(g) Develop a housing support crisis plan that includes prevention and early
intervention services when housing
is jeopardized; and
(h) Request an assessment of long-term home and community-based services
and supports.
HOUSING STABILIZATION SERVICES
After the individual has executed a rental lease agreement with the landlord of a
housing unit, and moved into that unit, the individual enters the Housing
Stabilization phase.
Housing Stabilization Services help an individual sustain living in their own
housing in the community. They include assisting the individual
to:
(a) Identify and build on strengths that are important to maintain housing in the
community;
(b) Obtain early identification
of and intervention for behaviors that may
jeopardize housing;
(
c) Obtain education and training on the roles, rights and responsibilities of the
tenant and landlord;
(d) Develop and maintain key relationships with the individual's landlord, with
a goal
of fostering successful tenancy;
(
e) Resolve disputes with landlords and/or neighbors to reduce risk of eviction
or other adverse action;
(t) Prepare a household budget;
(g) Enroll and obtain public benefits for which the individual is eligible for
(e.g., SNAP benefits, Veterans Affairs benefits, etc.);
(h) Identify and leverage natural community supports ( e.g., family, friends,
recreational clubs, support groups, etc.);
6 7404.3
7405
7405.1
(i) Learn independent living skills and activities
of daily living ( e.g., cooking,
housekeeping, basic finances, shopping, etc.);
G) Navigate the District's housing voucher recertification process;
(k) Review, update and modify their housing support and crisis plan on a
regular basis
to reflect current needs and address existing or recurring
housing retention barriers;
(1) Advocate for and access community resources to prevent eviction; and
(m) Help re-locate
to another housing unit, if warranted.
Housing Stabilization Services also include assisting
an individual to:
(a) Identify and access available community resources (e.g., food, toiletries,
household supplies, or transportation assistance);
(b) Connect to employment, education, volunteering, and/or other community
programming and resources ( e.g
., recreation centers, public libraries,
recreational clubs, or support groups)
to help prevent social isolation;
(
c) Identify and leverage family, friends, recreational clubs, support groups,
and other natural community supports that support the individual's tenancy;
and
(
d) Access somatic health, mental health, and substance use services, including
assistance with:
(1) Requesting
an assessment oflong-term home and community-based
services and supports;
(2) Scheduling appointments, writing directions, or scheduling
transportation; and
(3) Following up post appointment to ensure the individual understands
their services and when their next appointments are scheduled.
CONSUMER ENROLLMENT INTO HSS
The process used to enroll individuals into the HSS benefit shall:
(a) Effectively engage and offer support to individuals with disabilities or
disabling conditions experiencing chronic homelessness, who often
experience significant barriers to accessing care and housing;
7 7405.2
7406
7406.1
7406.2
7406.3
7406.4
7406.5
7406.6
(b) Align with the District's Coordinated Assessment and Housing Placement
(CAHP) system for housing assistance for people experiencing
homelessness; and
( c) Meet federal requirements related
to Medicaid home and community based
services (HCBS), set forth at
42 CFR § 441.710 (as may be amended).
Enrollment into the Medicaid HSS benefit will follow two (2) distinct processes
depending on whether the individual to
be enrolled is a participant in the PSH
program before or after the HSS benefit was established in the District.
INDIVIDUAL ENROLLMENT INTO HSS FOR PERSONS MATCHED TO
PSH PROGRAM AFTER HSS BENEFIT IMPLEMENTATION
The Department will deploy an HSS enrollment process for individuals determined
eligible for the PSH program through the CAHP system after the implementation
of the HSS benefit.
This HSS benefit enrollment process for individuals shall follow the process
described
at§ 7406.3 through§ 7406. 15.
The individual shall first undergo homeless services screening, which is the process
to determine eligibility for the PSH program through the CAHP system. The
process begins with a homeless services provider,
as defined at§ 2(30) of the Act,
or the Department, engaging individuals who are either experiencing homelessness
or at risk
of homelessness.
After the individual
is determined eligible for PSH program, through the CAHP
system, the Department shall complete a face-to-face assessment using a
standardized screening tool to evaluate whether the individual meets the HSS
eligibility criteria described at §
7401.
The Department will conduct face-to-face assessments in a range
of settings,
including locations where people who are experiencing homelessness are staying
or accessing services, or they may conduct assessments using telehealth (e.g.,
telephone or video meeting)
to ensure this process can be completed as safely and
quickly
as possible, and to minimize disruption for the individual.
The screening tool used to inform an HSS eligibility determination shall consider
an individual's evidence
of needs related to HCBS aimed to assist with achieving
and maintaining housing, with questions
in certain domains, including:
(a) Housing and homelessness, including duration
of current or recent episodes
of homelessness;
8 7406.7
7406.8
7406.9
7406.
10
7406. 11
(b) Risks, including recent utilization of hospital emergency department or
inpatient care, crisis services, self-harm or exposure to violence, or risks
of
exploitation;
(
c) Socialization and daily functioning, including the need for money
management or assistance with self-care, lack
of meaningful daily
activities, and unhealthy or abusive relationships that are a factor resulting
in homelessness; and
(d) Health and wellness, including chronic health conditions, physical
disabilities that limit access to housing or ability to live independently,
problematic drinking or drug use, mental health disorders or cognitive
impairments, and co-occurring health, mental health and substance use
disorders.
In addition
to conducting the assessment, the Department may also meet with the
individual's current service provider(s), or other persons who have been identified
by the individual and may review existing records or information records to draw
valid conclusions about their support needs.
The Department and the individual, in consultation with others chosen by the
individual, will develop a person-centered service plan that reflects their needs,
preferences, and strengths. This plan may be updated or revised by the individual
and their HSS provider, as needed.
At least annually, the Department will meet with the HSS individual to conduct an
assessment and update their person-centered service plan.
After a person-centered service plan has been developed for the individual, the
Department will provide a list
of available Department-certified HSS providers to
the individual and assist the individual in selecting an HSS provider.
Information offered for each HSS provider shall include:
(a) Name, location, and contact information for the HSS provider;
(b) Length
of time that the entity has been certified as an HSS provider; and
(
c) Information regarding the HHS provider's capacity to address client support
needs, including services available in other languages, accommodations, or
expertise in addressing specific types
of disabilities or needs, and
information about other relevant services and supports that may be offered
by the HSS provider or its community partners.
9 7406.12
7406.13
7406.14
7406.
15
7407
7407.1
7407.2
7407.3
7407.4
7407.5
An individual may request to change their HSS provider during their annual re
evaluation, verbally or in writing, to Department staff completing the annual re
evaluation.
When an individual asks to change their HSS provider mid-year, the Department
will review the request and documentation regarding the individual's needs and
preferences and attempt to mediate.
If the individual would still like to change their HSS provider after consultation
with the Department, the Department will assist the individual with selecting a new
HSS provider, notify the individual's current and newly selected HSS providers
of
the individual's request, and notate who the new HSS provider will be and when
the re-assignment to the new HSS provider will be effective in the Department's
case note system. The Department will also host a case conference between the
existing and new HSS providers
to review the individual's transition plan.
After the individual selects their HSS provider, the Department will formally assign
the selected HSS provider to the individual by updating the individual's profile in
the Department's case note system. This pairing shall prompt the HSS provider to
begin efforts to engage the individual and begin the provision
of HSS.
INDIVIDUAL ENROLLMENT INTO HSS FOR PERSONS MATCHED TO
PSH PROGRAM BEFORE HSS BENEFIT IMPLEMENTATION
The Department will deploy an HSS enrollment process for individuals determined
eligible for the PSH program through the CAHP system prior to the start
of the HSS
benefit. This section applies to individuals who are receiving services from a PSH
Provider.
This HSS benefit enrollment shall include the steps described
at§ 7407.3 through
§ 7407.
14.
The Department shall confirm the individual is receiving PSH services. The
Department shall compile a list
of all individuals enrolled in the PSH program (PSH
Program Participant List). This list shall indicate the PSH Provider and Medicaid
enrollment status for each individual included.
The Department shall update and finalize the PSH Program Participant List with
information presented
by the PSH Provider, through correspondence with each
PSH Provider included on this list.
After the PSH Program Participant list is confirmed, the Department shall contact
each consumer on the PSH Program Participant List to select a time to conduct a
functional assessment. 7407.6
7407.7
7407.8
7407.9
7407.
10
7407.11
7407.12
7407.
13
The Department shall establish a mechanism to conduct assessments with PSH
consumers outside
of standard business hours or on a limited ad hoc basis to
accommodate PSH consumers that are only available to meet in the evenings or on
weekends, or in instances when pre-scheduling an assessment time is challenging.
After a time for conducting the functional assessment and person-centered service
plan has been determined, the Department shall: •
(a) Jointly complete a face-to-face functional assessment with the PSH
consumer, as described at § 7406.6;
(b) Provide information to the PSH consumer
to facilitate their choice of HSS
Provider; and
(c) Update the PSH consumer's existing person-centered service plan.
When needed, the Department will work closely with the PSH consumer's PSH
Provider and other trusted entities
to complete the person-centered service plan.
The Department may use telehealth (e.g., telephone or video meeting) to meet with
the PSH consumer, and with the PSH consumer's consent, this may include their
current service provider or a trusted support person.
After the Department completes the functional assessment with the PSH consumer
and updates the PSH consumer's person-centered service plan,
as needed, the PSH
consumer may receive HSS services and be considered an HSS individual.
The Department shall support the HSS individual's choice to continue to receive
services from their existing PSH provider,
if that entity is also a HSS provider, or
to select a new HHS provider. The Department shall provide HSS individuals with
a list
of providers certified to provide HSS. Information offered for each HSS
provider shall include information listed
at§ 7406.11.
If the HSS individual selects an HSS provider that is also the current PSH provider,
the Department shall confirm that the HSS individual
is linked to the HSS provider
in the Department's case note system.
If the HSS individual selects an HSS provider that is not the current PSH provider,
the Department shall notify the HSS individual's current PSH provider and newly
selected HSS provider
of the choice made, confirm the individual's transition plan
with their current PSH provider and new HSS provider, and then notate the
individual's chosen HSS provider and transition date in the Department's case note
system.
11 7407.14
7407.15
7407.16
7408
7408.1
7408.2
7408.3
If the HSS individual chooses to receive services from an HSS provider that is
different than their current provider, the current provider shall develop a transition
plan that supports the individual's successful transition to the new HSS provider.
An HHS individual's transition date from one HSS provider to another HSS
provider shall be the first day
of the month following the date in which the
individual's request
to transition is received by the Department.
The HSS provider shall continue to deliver services
to the HSS individual, if the
HSS provider was already previously delivering services to the individual
as a PSH
provider.
If the HSS provider has no immediate historical relationship with the HSS
individual
as a PSH provider, the HSS provider shall initiate services to their newly
enrolled HSS individual.
INDIVIDUAL SERVICE PLAN DEVELOPMENT
As part of the HSS benefit enrollment process described at§§ 7406 and 7407, the
Department shall develop an Individual Service Plan (ISP) for, and in collaboration
with, the individual, using a person-centric, strengths-based approach.
The ISP shall:
(a) Reflect priorities important to the individual;
(b) Consider the individual's beliefs, values, and cultural norms in how, what,
and by whom HSS are to
be provided;
(c) List appropriate and measurable goals and objectiv
es related to the
individual's desired housing-related outcomes;
(
d) Describe recommended service interventions that will address the
individual's needs; and
(
e) Serve as written guidance the individual may use in moving toward housing
stability.
The ISP shall include the following elements:
(a) Overall goal statement that captures the individual's short-and long-term
goals for the future, ideally written in first-person language. This shall
include the individual's self-identified housing-related goals;
(b) List or statement
of individual or family strengths that support goal(s)
accomplishment. These include abilities, talents, accomplishments, and
resources;
12 7409
7409.1
7409.2
7409.3
7409.4
(c) List or statement
of barriers that pose obstacles to the individual's or
family's ability to accomplish the stated goal(s). These include symptoms,
functional impairments, lack
of resources, consequences of behavioral
health issues, and other challenges; and
(
d) Statement of objectives that identify the short-term individual or family
changes in behavior, function, or status that can help overcome the
identified barriers to housing stability. Objective statements describe
outcomes that are measurable and include individualized target dates to be
accomplished within the scope
of the plan.
HSS PROVIDER REQUIREMENTS -GENERAL
Each HSS provider shall:
(a) Comply with all related federal and local confidentiality laws;
(b) Comply with all provisions
of the Homeless Services Reform Act of 2005
(HSRA or Act),
as amended, D.C. Law 16-35; D.C. Official Code § 4-
756.02 and corresponding regulations;
(c) Have and maintain a PSH Human Care Agreement (HCA) with the
Department and comply with the requirements stated in their PSH HCA;
(d) Enroll and maintain enrollment in the District's Medicaid program as an
HSS provider:
(e) Enroll eligible individuals into the Medicaid benefit and maintain monthly
enrollment
of all individuals;
(t) Submit all requested program and financial information
to the Department
for evaluation and auditing purposes; and
(g) Provide clinical management for its enrolled individuals.
Each HSS provider shall satisfy the minimum staffing requirements set forth in this
section and§ 7411.
Each HSS provider shall comply with the certification standards described in this
Chapter.
Each HSS provider shall provide to the District information that the District
determines
is reasonably necessary to:
(a) Monitor and evaluate the HSS provider's compliance with the terms of its
HCA with the Department and Medicaid Provider Agreement, including:
13 7409.5
7409.6
7409.7
7409.8
conducting claims audits, Medicaid compliance reviews, quality reviews,
and any other program integrity function
to ensure the quality, effectiveness
and efficiency
of services and ensuring the accuracy of claims submitted for
reimbursement under this agreement; and
(b) Verify the costs
of services required m the HCA, including all
administrative, direct, and indirect costs.
Each HSS provider shall have
an annual audit by an independent certified public
accountant or a certified public accounting firm in accordance with generally
accepted auditing standards. The resulting financial audit report shall be consistent
with formats recommended by the American Institute
of Public Accountants. The
HSS provider shall submit a copy
of their financial audit report to the Department
within one hundred and twenty (120) calendar days after the end
of the provider's
fiscal year.
Each HSS provider shall document all notes describing individual engagement
activities in the Department's web-based case note platform. All case notes shall be
documented using the Data Assessment and Plan (DAP) format unless otherwise
indicated by the Department.
Each HSS provider shall document each activity provided in each individual's
record in the Department's web-based case note platform to include, at minimum:
(a) A description
of the specific activity rendered and whether it should be
categorized
as supporting the consumer's Housing Navigation or Housing
Stabilization;
(b) The date and time the service(s) were rendered;
(c) The HSS provider staff member who provided the services;
(d) The setting in which the service(s) were rendered; and
(e) The individual's person-centered plan
of care provisions related to the
service(s) provided.
Each HSS Provider shall have the capacity
to receive and review information from
the District's Health Information Exchange (DC HIE) that states, at minimum, the
dates and times individuals on the HSS provider's caseload are admitted
to a
hospital, discharged from a hospital or transferred between departments within a
hospital. Information that the HSS provider receives from the DC HIE will be
emailed
to the provider in a CSV ( comma-separated values) format, such as
Microsoft Excel, or uploaded to the provider's electronic health record system (
as
applicable).
14 7409.9
7410
7410.1
7410.2
7410.3
7410.4
7410.5
7410.6
7411
7411.1
7411.2
Each HSS provider shall report any suspicion
of abuse, neglect, self-neglect, and/or
exploitation
of individuals to the Adult Protective Services Hotline. The HSS
provider shall also notify the Department in writing no later than the next business
day following the suspicion.
HSS PROVIDER REQUIREMENTS -ISP IMPLEMENTATION
The HSS provider shall monitor the individual's progress towards meeting their
ISP goals. The ISP shall be reviewed with the individual,
as needed or at a minimum
frequency defined in the HSS provider's HCA with the Department.
The HSS provider shall make person-centered and strengths-based updates to an
individual's ISP
as needed. Updates shall be made regarding the individual's needs
and shall reflect priorities important to the individual. Any updates establish or
further already established appropriate and measurable goals and objectives,
desired outcomes, and recommended service interventions that will address the
individual's needs and assist the individual in moving toward self-sufficiency and
housing stability.
The HSS provider shall make referrals
to and partner with other agencies, as
necessary and appropriate, to support individual's supportive needs, including
behavioral health (e.g., mental health, substance abuse), educational, technical and
trade supports, parenting skills and support, legal, financial, family and child
support, early intervention, and senior and disability supports.
The HSS provider shall establish referral and follow-up procedures to confirm and
track participation in all referrals made
to other agencies. Documentation of
referrals made, and referral confirmation shall be documented in the Department's
case note system.
The HSS provider shall document in the individual's record, existing in the
Department's case note system, whether an individual's court-appointed guardian,
family, or significant others participated in the development
of the ISP.
In situations where the individual does not demonstrate the capacity to sign or does
not sign their ISP, the reasons the individual does not sign shall be recorded in the
individual's record, existing in the Department's case note system, including each
date when obtaining a signature was attempted.
HSS PROVIDER REQUIREMENTS -PERSONNEL
The HSS provider shall employ the key personnel described in this Chapter, all of
whom shall meet the described requirements listed in the HSS provider's HCA with
the Department.
Key personnel include persons that fill the following positions:
15 7411.3
7411.4
(a) Program Director (or equivalent);
(b) Case Manager Supervisor; and
(
c) Case Manager ( or equivalent).
General responsibilities
of the Program Director (or equivalent) shall include:
(a) Facilitate mediation with individuals and case managers;
(b) Develop tracking systems to allow for accurate reporting;
(
c) Identify training needs and assist with training staff;
(
d) Participate in monthly District/Provider meetings;
(
e) Collaborate with the Department in the development and maintenance of
inter-and intra-agency relationships in support of the continuum of services
to individuals;.
(f) Act
as a liaison with landlords and other community organizations to build
relationships and to promote the success
of PSH Program;
(g) Maintain knowledge regarding community resources for marginalized
communities;
(h) Ensure their Agency
is following all District policies and procedures related
to homeless service programming;
(i) Coordinate and conduct intake meetings/trainings with new program staff
to explain the HSS benefit ;
(j) Develop and implement quality control and quality improvement strategies;
(k) Review applicable databases (e.g., the Department's web-based case note
platform and the Homeless Management Information System (HMIS)) for
data quality and completeness; and
(1) Conduct monitoring of program performance on a regular basis.
General responsibilities
of the Case Manager Supervisor shall include, but not be
limited to:
(a) Provide clinical oversight;
16 7411.5
(b) Monitor and track case manager engagement with individuals;
( c) Review case notes through the lens
of quality of information captured and
accuracy
of case notes, clinical lenses;
(
d) Review, evaluate, and approve participant case plans for quality and
effectiveness;
(e) Meet individually with case managers to plan and review cases, discuss
engagement strategies and evaluates the effectiveness
of the case manager
and services;
(f) Review and approve all notices issued to individuals for accuracy and
completion;
(g) Engage in case conferences with the Department to discuss cases that may
need to include more intensive case management or transfers; and
(h) Meet requirements included in the provider's HCA with the Department.
General responsibilities
of the Case Manager shall include:
(a) Serve as the case manager and service coordinator for assigned individuals;
(b) Build rapport with the individual;
(
c) Assess the individual's strengths, needs, and preferences;
(
d) Assist the individual in specifying and articulating their goals and
developing their plan
to reach them;
(
e) Meet with the individual, including engaging with the individual in the
home setting;
(f) Develop and support the individual in achieving the goals included in their
ISP;
(g) Facilitate and ensure connection to needed community services and work in
collaboration with community agencies to ensure effective communication
and individual engagement;
(h) Connect assigned individuals to, and ensure their engagement in, needed
supportive services that will address barriers and challenges they face;
(i) Track individuals engagement/participation in supportive services,
workforce development, employment training;
17 7411.6
7411.7
7411.8
7411.9
7411.10
7411.11
(j) Complete all required case notes, housing stabilization plans, documents,
files, and assigned reports related
to individual/case activity;
(k) Develop and maintain individual's records/files that comply with all federal
laws, requirements established in this Chapter and standards set forth in the
HSS provider's HCA with the Department;
(1) Complete comprehensive monthly budgets with individuals;
(m) Input individual data and program activities into designated software
database
as assigned;
(n) Prepare and issue all Notices to individuals (i.e., Exit, Termination,
Extension Notices);
(o) Enter individual housing information into HMIS and the Department's web-
based case note platform; and
(p) Fulfill requirements included in the provider's HCA with the Department.
If more than one person employed by the HSS provider will be performing case
management tasks, the HSS provider shall identify a primary case manager
responsible for coordinating and documenting the service delivery for the
individual and document the rationale.
The HSS provider shall fill a vacant key personnel position within sixty (60)
business days
of vacancy, or within the timeframe established in the provider's
HCA with the Department, whichever
is shorter.
The Department reserves the right to review the resumes
of the HSS provider's staff
upon request.
The Department will monitor compliance with the staffing requirements for all staff
through periodic audits and reserves the right to change or remove any HSS
provider or sub-provider staff based on qualifications
of personnel not meeting the
requirements.
The Department reserves the right to change or remove any HSS provider or sub
provider staff based on unsatisfactory performance at no additional cost to the
District.
Each HSS provider's key personnel shall comply with training requirements
established in its HCA with the Department.
18 7412 HSS PROVIDER REQUIREMENTS -HOUSING NAVIGATION
SERVICES
7412.1
7412.2
7412.3
7412.4
7412.5
When delivering Housing Navigation Services, the HSS provider shall:
(a) Initiate and sustain engagement with the individual that facilitates the
creation
of rapport with the individual; and
(b) Leverage its rapport with the individual to provide Housing Navigation
Services geared toward supporting the individual's lease-up to a housing
unit.
The HSS provider shall use multiple approaches to contact and engage with the
individual. In-person and telephonic outreach attempts should be made at varying
times
of day, at varying locations where the individual is known to sometimes be
found and shall be proactive in nature.
In addition to the document requirements listed in this Chapter, documentation of
outreach attempts shall clearly note type of attempt, and information or notes left
behind for the individual. Examples
of outreach attempts include:
(a) Attempting
to locate the individual through outreach conducted via a
Homeless Outreach Provider Team, State Opioid Response Team, or the
DC Department
of Behavioral Health Critical Response Team;
(b) Traveling to the site/location listed on the individual's most current District
approved standardized screening tool or listed in HMIS;
(c) Visiting area homeless shelter(s)
to locate the individual; and
(
d) Attempting to locate the individual by attending a CARP meeting attended
by other homeless services providers who may have information about the
individual.
While the individual is in the Housing Navigation phase, the HSS provider shall
engage with the individual at the frequency established in the HSS provider's HCA,
but at least one time per week, with a minimum
of two (2) face-to-face contacts
each month.
The HSS provider must document each Housing Navigation engagement with the
individual. The documentation shall describe, at minimum, the date and time
of the
engagement, and include the individual's housing barrier(s) addressed (lack
of vital
documents, criminal history, poor credit, or past evictions). The Department may
require additional documentation for each engagement with the individual.
19 7412.6
7412.7
7413
7413.1
7413.2
7413.3
7413.4
7413.5
7413.6
7414
7414.1
The HSS provider shall ensure case managers build rapport with the individuals
and their landlords during Housing Navigation.
In addition to the required minimal face-to-face frequency
of engagement with
individuals in the Housing Navigation phase, the HSS provider may maintain
connection with the individual via email, text, telephone, video phone or other
secure methods depending on the individual's preference.
HSS PROVIDER REQUIREMENTS -HOUSING STABILIZATION
SERVICES
After the individual has executed a rental lease agreement with the landlord of a
housing unit, and moved into that unit, the individual enters the Housing
Stabilization phase.
The HSS provider shall ensure continuity and effectiveness
of service delivery. The
HSS provider shall have regular contact with individuals.
The HSS provider shall have a minimum
of two (2) contacts with an individual per
month, where at least one
of these contacts shall be face-to-face with the individual.
The other contact may be accomplished through other interactive methods.
Examples include email, text, telephone, video phone, or other secure methods,
depending on the individual's preference, needs, and abilities.
The provider shall exert concerted and deliberate efforts
to meet with the individual
face-to-face in their home. The home environment is a critical factor in the
individual's housing stability, particularly in the areas
of physical and behavioral
health status, economic security, self-sufficiency, and compliance with lease
requirements.
The HSS provider must document each Housing Stabilization engagement with the
individual. The documentation shall describe, at minimum, the date and time
of the
engagement and outline goals, meeting purpose, and service(s) provided.
The HSS provider shall take the lead
to schedule all meetings with the individual
at a mutually agreeable time that does not conflict with an individual's work
schedule, medical appointments, school events, or other appointments that are part
of their ISP.
HSS PROVIDER QUALIFICATIONS
The HSS provider shall be established as a legally recognized entity in the District
of Columbia and qualified to conduct business in the District. A certificate of good
standing and valid basic business license, both issued by the District
of Columbia
Department
of Consumer and Regulatory Affairs, shall be evidence of qualification
to conduct business.
20 7414.2
7414.3
7414.4
7414.5
The HSS provider shall:
(a) Have a governing body with oversight responsibility for administrative and
programmatic policy development, monitoring and implementation;
(b) Comply with all applicable Federal and District laws and regulations;
( c) Hire personnel with the qualifications necessary to provide HSS and
to meet
the needs
of its enrolled consumers, as described at§ 7411;
(
d) Ensure that independently licensed qualified practitioners are available to
provide appropriate and adequate supervision
of all clinical activities; and
(e) Employ qualified practitioners that meet all professional requirements as
defined by the applicable licensing, certification, and registration laws and
regulations
of the District or the jurisdiction where services are delivered.
The HSS provider shall comply with the cost survey and program integrity audits
set forth in Chapter
103 of Title 29 DCMR.
The HSS provider shall obtain background check documents for all persons
employed by the HSS provider, including subcontracted staff or any volunteers
with direct contact with program individuals, and submit these documents
to the
Department.
Background check documents for all HSS provider personnel must be current,
within two (2) years
of submission date, and include:
(a) A current government issued photo Identification (ID) (e.g., driver's
license, state issued ID, or passport);
(b) Evidence
of each staff member's licensure, certification, or registration, as
applicable and as required by the job being performed;
(c) For non-licensed staff, evidence
of completion of an appropriate degree,
appropriate training program, or appropriate credentials (e.g., an academic
transcript or a copy
of degree);
(
d) Evidence of all required criminal background checks, and for all
staff members, application
of the criminal background check requirements
contained in the HSS Provider's HCA with the Department;
(e) Evidence
of quarterly checks that no individual is excluded from
participation in a federally funded health care program as listed on the
Department
of Health and Human Services' "List of Excluded
21 7414.6
7414.7
7414.8
7414.9
7414.10
7414.11
7414.12
7414.13
Individuals/Entities," the General Services Administration's "Excluded
Parties List System," or any similar succeeding governmental list; and
(f) Evidence
of completion of all communicable disease testing required by the
Department and District laws and regulations.
The HSS provider shall conduct each required screening for all staff at the
frequency required
by District law and regulations or by the Department, whichever
is most stringent.
The Department must clear each person employed by the HSS provider, including
subcontracted staff or any volunteers with direct contact with program individuals,
for fitness before beginning work or having contact with individuals.
The HSS provider shall ensure that any applicant for a compensated position and
candidates for unsupervised volunteer positions complete the required criminal
background screening before any such applicant or candidate may be offered a
compensated position or an unsupervised volunteer position with the HSS Provider.
The HSS provider must provide the Department the process
by which an applicant
for employment, including subcontractors or any volunteers with direct contact
with program individuals, shall declare any present or past events that might raise
liability or risk management concerns, such as malpractice actions, insurance
cancellations, criminal convictions, Medicare/Medicaid sanctions, and ethical
violations.
The HSS provider shall ensure all employees are not adversely affected
by alcohol,
illegal drugs, or legal drug use during work hours. The HSS provider shall have an
active drug-free workplace policy and shall utilize drug testing
to ensure that each
job applicant, employee, and unsupervised volunteer are not under the influence
of
drugs or alcohol while working with program individuals.
The HSS provider shall complete a suitability screening for each employee as
outlined in its HCA with the Department.
The HSS provider shall establish and adhere to policies and procedures responding
to individual grievances and incorporate this information into its HSS Program
Rules
as described in Section 18 of the Act.
The HSS provider shall establish uniform procedures for employees to file
grievances, in writing, to the provider (including requests for case manager
reassignments) and shall post these procedures in applicable paperwork,
administrative offices, and in the facilities used to provide services. The procedures
for filing grievances shall be a part
of the provider's employee handbook shall be
approved by the District.
22 7414.14
7414.15
7414.
16
7414.17
7414.18
7414.
19
7414.20
7414.21
The HSS provider shall have a written plan for staff development and
organizational onboarding, approved by the Department, which reflects the training
and performance improvement needs
of all employees working in that program.
The HSS provider shall establish and adhere
to policies and procedures for record
documentation, security, and confidentiality
of individual and family information;
clinical records retention, maintenance, purging and destruction; disclosure
of
individual and family information; and informed consent that comply with
applicable Federal and District laws and regulations.
The HSS provider shall have the necessary operational capacity to submit claims
for Medicaid-reimbursable HSS and invoices for locally-reimbursed PSH services,
document information on services provided, and track payments received. This
operational capacity shall include the ability
to:
(a) Verify eligibility for Medicaid and other third-party payers;
(b) Document HSS provided by Department-certified HSS provider staff and
sub-Provider;
(
c) Submit claims and invoices, and relevant documentation ofHSS on a timely
basis in compliance with applicable requirements
of the Department and
DHCF; and
(
d) Track payments for all provided HSS.
The HSS provider shall comply with requirements
of the District of Columbia
Language Access Act
of 2004, as amended, D.C. Official Code§ 2-1931, et seq.
The HSS provider shall also comply with requirements listed in Section 1557
of
the Patient Protection and Affordable Care Act, as amended, 42 U.S.C. § 18116(a).
The HSS provider shall comply with applicable provisions
of the Americans with
Disabilities Act
of 1990, 42 U.S.C. § 12101, et seq., in all business locations.
The HSS provider shall utilize a TeleTYpe (TTY) telecommunications line (or an
equivalent)
to enhance the HSS provider's ability to respond to service requests and
needs
of individuals and potential individuals. HSS provider staff shall be trained
in the use
of such communication devices as part of the annual language access
training.
The HSS provider shall establish and adhere to anti-discrimination policies and
procedures relative
to hiring, promotion, and provision of services to individuals
that comply with applicable Federal and District laws and regulations (Anti
Discrimination Policy).
23 7414.22
7414.23
7414.24
7414.25
The HSS provider shall have established by-laws or other legal documentation
regulating the conduct
of its internal financial affairs. This documentation shall
clearly identify the individual(s) that are legally responsible for making financial
decisions for the HSS provider and the scope
of such decision-making authority.
The HSS provider shall:
(a) Maintain an accounting system that conforms to generally accepted
accounting principles, provides for adequate internal controls, permits the
development
of an annual budget, an audit of all income received, and an
audit
of all expenditures disbursed by the HSS provider in the provision of
services;
(b) Have an internal process for the development
of interim and annual
financial statements that compares actual income and expenditures with
budgeted amounts, accounts receivable, and accounts payable information;
and
(c) Operate in accordance with an annual budget established by its governing
authority.
The HSS provider shall establish and adhere to policies and procedures governing
the retention, maintenance, purging and destruction
of its business records, that:
(a) Comply with applicable Federal and District laws and regulations;
(b) Require the HSS provider to maintain all business records pertaining
to
costs, payments received and made, and services provided to individuals for
a period
of ten (10) years or until all audits are completed, whichever is
longer; and
(c) Require the HSS provider to allow the Department, DHCF, the District's
Inspector General, HHS, the Comptroller General
of the United States, or
any
of their authorized representatives to review the HSS provider's
business records, including client clinical and financial records.
The HSS Provider, at its expense, shall:
(a) Obtain at least the minimum insurance coverage required by its HCA; and
(b) Make evidence of its insurance coverage available to the Department upon
request.
The HSS provider shall operate according to all applicable Federal and District laws
and regulations relating to fraud, waste, and abuse in health care, the provision
of
mental health services, and the Medicaid program. An HSS provider's failure to
report potential or suspected fraud, waste or abuse may result in sanctions,
24 7414.26
7414.27
7414.28
7415
7415.1
7415.2
cancellation
of contract, or exclusion from participation as an HSS provider. The
HSS provider shall:
(a) Cooperate and assist any District or Federal agency charged with the duty
of identifying, investigating, or prosecuting suspected fraud, waste, or
abuse;
(b) Provide the Department with regular access to the HSS provider's medical
and billing records, including electronic medical records, within twenty
four (24) hours
of a Departmental request, or immediately in the case of
emergency;
(
c) Be responsible for promptly reporting suspected fraud, waste, or abuse to
the Department, taking prompt corrective actions consistent with the terms
of any contract or subcontract with the Department, and cooperating with
DHCF or other governmental investigations; and
(
d) Ensure that none of its practitioners have been excluded from participation
as a Medicaid or Medicare provider.
If a practitioner is determined to be
excluded by CMS, the HSS provider shall notify the Department
immediately.
The HSS provider shall ensure that sufficient resources
(e.g., personnel, hardware,
or software) are available
to support the operations of computerized systems for
collection, analysis, and reporting
of information, along with claims submission.
The HSS provider shall have the capability to submit accurate claims, number
of
engagement with each individual on a monthly basis, and other submissions as
necessary directly
to the Department.
The HSS provider does not normally need an individual's detailed health
information, such
as diagnosis or specific services received, or full access to
medical records (particularly for behavioral health conditions or sensitive
information like HIV status). However, the HSS provider shall have a clearly
defined protocol to prevent inappropriate information sharing that might violate the
Health Insurance and Portability and Accountability Act
of 1996 (P.L. 104-191), as
amended (HIPAA) or Section
543 of the Public Health Service Act (P.L. 102-321).
HSS PROVIDER CERTIFICATION PROCESS
The Department shall use its HCA contracting process to certify each entity as an
HSS provider.
The Department shall utilize the certification process to thoroughly evaluate the
applicant's capacity
to provide high quality HSS in accordance with these
regulations and the needs
of the District's Continuum of Care.
25 7415.3
7415.4
7415.5
7415.6
7415.7
7415.8
No person or entity shall provide HSS unless certified by the Department.
Certification shall remain in effect until it expires,
is renewed, or is revoked.
Certification shall be considered terminated
if the HSS provider is no longer party
to a PSH HCA with the Department.
Certification
is not transferable to any other organization.
Nothing in this Chapter shall be interpreted to mean that certification
is a right or
an entitlement. Certification
as an HSS provider depends upon the Department's
assessment
of the need for additional HSS providers and availability of funds. An
entity that applies for certification during
an open application period as published
in the District
of Columbia Register may appeal the denial of certification under
this subsection by utilizing the procedures contained in 27 DCMR Ch.
3. The
Department shall not accept any applications for which a notice
of moratorium is
published in the District of Columbia Register.
The HSS provider shall notify the Department in writing thirty (30) calendar days
prior to implementing any
of the following operational changes, including all
aspects
of the operations materially affected by the changes:
(a) A proposed change in the name or ownership
of an HSS provider owned
by an individual, partnership, or association, or in the legal or beneficial
ownership
of ten percent (10%) or more of the stock of a corporation that
owns or operates the HSS provider;
(b) A change in affiliation or referral arrangements;
(c) A proposed change in the location
of the provider's headquarter location;
(
d) The proposed addition or deletion of services, which is anything that
would alter or disrupt services where the consumer would be impacted by
the change, or any change that would affect compliance with this Chapter;
(
e) A change in the required staff qualifications for employment;
(f) A change in the staff filling positions required by this Chapter;
(g) A proposed change
in organizational structure; or
(h) A proposed change in the population served.
26 7415.9
7415.10
7415.11
7416
7416.1
7416.2
The HSS provider shall forward
to the Department within thirty (30) calendar days
all inspection reports conducted by an oversight body and all corresponding
corrective actions taken regarding cited deficiencies.
The HSS provider shall immediately report
to the Department any criminal
allegations involving provider staff.
In order to maintain certification, a HSS provider shall:
(a) Participate in activities supporting the successful implementation of the
HSS program, including:
(1) Trainings to foster professional competency and development
of
best practices related to person-centered planning, chronic disease
self-management, and related topics;
(2) Continuous quality improvement tasks, monitoring and
performance reporting;
(3) District-wide initiatives
to support the exchange of health
information; and
(4) Evaluations required by CMS, DHCF or the Department;
(b) Maintain compliance with all requirements set forth in this Chapter; and
( c) Maintain compliance with all terms and conditions set forth in the HSS
provider's HCA with the Department and its DC Medicaid provider
agreement including all modifications,
as well as with all applicable federal
and District laws.
DENIAL OF CERTIFICATION OR DECERTIFICATION PROCESS
Only an organization with an executed PSH HCA with the Department may be
considered certified by the Department
to deliver HSS.
An organization that
is not awarded a PSH HCA with the Department, or is unable
to maintain a PSH HCA with the Department, and thus becomes decertified as an
HSS provider, may protest the Department's decision through the following steps:
(a) Submit written correspondence to the Department to convey its intent
to
protest the Department's decision, and
(b) Request that the District
of Columbia Contract Appeals Board hear the
case to determine whether the Department's decision should be upheld or
27 7417
7417.1
7417.2
7417.3
7417.4
7417.5
7418
7418.1
7418.2
7418.3
7419
7419.1
reversed, in accordance with Chapters
1, 2, 3, and 4 of Title 27 DCMR,
as amended.
HSS PROVIDER DISCONTINUATION OF SERVICES, PROVIDER
CLOSURES, AND CONTINUITY OF INDIVIDUAL CARE
An HSS provider shall provide written notification to the Department at least ninety
(90) calendar days prior to its impending closure, or immediately upon knowledge
of an impending closure. This notification shall include plans for continuity of care
and preservation
of individual records.
The Department shall review the continuity
of care plan and make
recommendations to the HSS provider as needed. The plan should include provision
for the referral and transfer
of individuals.
The HSS provider shall incorporate all Department recommendations necessary to
ensure a safe and orderly transfer
of care.
Closure
of an HSS provider does not absolve an HSS provider from its legal
responsibilities regarding the preservation and the storage
of individual records as
described
at§ 7414.15 of these regulations and all applicable Federal and District
laws and regulations. The HSS provider shall take all necessary and appropriate
measures to ensure individual records are preserved, maintained, and made
available to individuals upon request after closure
of a provider or discontinuation
of the applicable service.
An HSS provider shall be responsible for the execution
of its continuity of care plan
in coordination with the Department.
INDIVIDUAL PROTECTIONS
Medicaid individuals are entitled to Notice and Appeal rights pursuant to 29 DCMR
§ 9508 in cases
of intended adverse action, such as an action to deny, discontinue,
terminate, or change the manner or form
of Medicaid-funded HSS.
The HSS provider shall establish and adhere to a consumer rights policy that aligns
with Section 9
of the Act.
The HSS Provider shall establish and adhere to policies and procedures governing
the release
of information about individuals, which comply with applicable Federal
and District laws and regulations.
QUALITY ASSURANCE AND IMPROVEMENT
The HSS provider shall submit to the Department a quality improvement plan that
describes how the provider will ensure and measure for each individual:
28 7419.2
7419.3
7420
7420.1
7420.2
7420.3
7420.4
(a) Timely access to and availability of services; and
(b) Adequacy, appropriateness, and quality of care, including treatment and
prevention
of acute and chronic conditions.
The HSS provider's quality improvement plan shall describe its protocols
to:
(a) Closely monitor individuals with severe housing stability barriers and
children and youth within
an individual's household with complex service
needs;
(b) Coordinate individual services with behavioral health providers; and
(
c) Collect and respond to individual satisfaction with services delivered by the
Provider.
The HSS provider's quality improvement plan shall be approved by the Department
annually.
REIMBURSEMENT
Effective April 1, 2022, the District shall establish a per member per month
(PMPM) rate to reimburse HSS providers for the provision
of HSS delivered to
individuals enrolled in the DC Medicaid program using a PMPM payment
structure. The PMPM rate shall be determined in accordance with 29 DCMR §
103.3.
The HSS PMPM reimbursement rate shall be seven hundred and fifty-five dollars
and twenty-one cents ($755.21). Upon the launch
of the HSS benefit, this rate, and
any amendments
to this rate, will be published on the DHCF website at www.dc
medicaid.com and in accordance with 29 DCMR § 988.4.
The Department shall reimburse HSS providers, using a PMPM payment structure,
for the provision
of PSH services to individuals that are not eligible for enrollment
in the District Medicaid HSS program, or that temporarily lose their Medicaid
enrollment status. The PMPM rate paid by the Department shall equal the rate
described above at §7420.2 and in accordance with 29 DCMR § 988.4.
The Department shall reimburse HSS providers for the provision
of adjunct services
that facilitate the provision
of HSS and promote the housing stability of adult
individuals on a monthly basis. The reimbursement rates for each type
of service
are detailed below or in the Department's HCA with the HSS provider:
(a) Services provided
to minors in an adult individual's household, at a rate of
four hundred dollars ($400) per household, per month;
29 7420.5
7420.6
7420.7
7420.8
7420.9
7420.10
7420. 11
(b) Utility assistance;
(c) Financial assistance; and
(
d) Staff onboarding.
To be eligible for a PMPM payment for PSH services for an individual receiving
Housing Navigation Services, a PSH provider shall deliver any service listed at §
7403
of this Chapter at a minimum frequency of once a week within the month. At
least two (2)
of these services shall be delivered face-to-face with the client. The
other contacts may be made by telephone, email, text, or another electronic format.
To be eligible for a PMPM payment for PSH services for an individual receiving
Housing Stabilization Services, a PSH provider shall deliver any service listed at
§ 7404
of this Chapter at a minimum frequency of twice a month. At least one of
these services shall be delivered face-to-face with the client. The other contact may
be made by telephone, email, text, or another electronic format.
To receive a PMPM payment for PSH services delivered to minors in the eligible
individual's household, the HSS provider shall provide services at the scope and
frequency described in the HSS provider's HCA with the Department.
For individuals not eligible for reimbursement through the District's Medicaid
program, each HSS Provider shall submit a monthly invoice to the Department for
reimbursement within thirty (30) days
of the date of service or of the date a
Medicaid claim is denied for the same date
of service.
Reimbursement to
an HSS provider for the provision of HSS to individuals
participating in the DC Medicaid HSS benefit shall be in accordance with Chapter
103 (Medicaid Reimbursement for Housing Supportive Services), to Title 29
(Public Welfare),
of the District of Columbia Municipal Regulations (DCMR).
An HSS provider's submission of an invoice to the Department for PSH delivered
to an adult individual will serve as the HSS provider's attestation that avenues for
Medicaid reimbursement for the services have been exhausted, and that the HSS
provider has followed all necessary procedures and policies for supporting the
individual's initial and continued enrollment in the District's Medicaid program.
An HSS provider shall not submit an invoice to the Department for a Medicaid
claim that
is not submitted or denied because the submission was unacceptable or
untimely.
30 7420.12
7420.
13
7421
7421.1
An HSS provider shall be eligible
to receive one PMPM rate for HSS services
provided
to an adult individual, and, if applicable, one additional PMPM rate for
PSH services provided to minors within the adult individual's household.
Any claim submitted to Medicaid for reimbursement or invoice submitted to DHS
for reimbursement for program services shall be supported by written
documentation in the individual's record
in the Department's case note system,
according
to the standards described in this Chapter.
NON-REIMBURSABLE SERVICES
The following services are not covered as HSS:
(a) Room and board residential costs;
(b) Inpatient hospital services, including hospital, nursing facility, intermediate
care facility for individuals with intellectual disabilities, and institutions for
mental diseases;
(
c) Prescription drug costs;
(
d) Transportation services;
(
e) Financial deposits:
(t) Food;
(g) Furnishings;
(h) Utilities;
(i) Moving expenses;
U) Rent;
(k) Educational, vocational, and job training services;
(1) Services rendered by parents or other family members;
(m) Social or recreational services;
(n) Services that are not provided and documented in accordance with these
certification standards; and
( o) Services furnished to persons other than the consumer when those services
are not directed primarily
to the well-being and benefit of the individual.
31 7499
7499.1
7499.2
DEFINITIONS
The terms in this Chapter shall have the definitions set forth in Section 2 of the Act.
In addition, the following terms in this Chapter shall have the meaning ascribed:
Act-the Homeless Services Reform Act of 2005, effective October 22, 2005 (D.C.
Law 16-35; D.C. Official Code§ 4-751.01, et seq.),
as amended.
Assessment - a clinical evaluation performed by a qualified group or individual of
the consumer's physical, mental, behavioral, social, and emotional health.
It considers the consumer's s perception
of self and ability to function
socially at home and in the community, and relevant historical data
as it
impacts the quality
of the consumer's life.
Case management - a set of services and interventions focused on assisting HSS
individuals to obtain and retain permanent housing, move toward the
greatest degree
of self-sufficiency, and are based on the consumer's goals
and preferences outlined in their
ISP. These services include coordination
of and assisting consumers to access financial assistance, tenancy support,
social services, health care services, and other resources available in the
community.
Case note - a chronological record of the delivery of services and support to head
of households and their dependent and/or minor children. Case notes also
provide the necessary documentation to support claims
to funding sources,
and provide a single place for case managers, social workers, supervisors
and colleagues, state and federal auditors and others with appropriate access
to read about recent case activity.
Certification - the written authorization from the Department rendering an entity
eligible to provide HSS.
Certification standards - the mm1mum requirements established by the
Department in this Chapter that a provider shall satisfy
to obtain and
maintain certification
to provide HSS and receive reimbursement from the
District for HSS.
Collateral contact-an individual involved in the individual's care. This individual
may be a family member, guardian, healthcare professional or person ( e.g
.,
landlord/property manager, lawyer) who is a knowledgeable source of
information about the individual's situation and serves to support or
corroborate information provided by the individual. The individual
contributes a direct and
an exclusive benefit for the individual.
32 Consumer - an individual client as defined in section 2(7) of the Act.
Coordinated Assessment and Housing Placement (CAHP) System - the
District's "centralized or coordinated assessment system"
as defined in
section 2(6A)
of the Act, also referred to as coordinated entry or coordinated
intake, and further defined in publicly available CARP governance
guidance.
Data Assessment Plan (DAP) - a standard used to define a comprehensive case
note in the Department's web-based case note system. The term 'Data'
is
defined as the subjective and objective information about the individual's
goals and progress made toward them. The term 'Assessment'
is defined as
a written note completed by the individual's case manager that describes the
case manager's observations about the individual's interactions with family
members, the individual's motivation to move toward their goals and the
tone, and affect and demeanor
of the individual, along with how the
individual is maintaining their housing unit. The term 'Plan'
is defined as
the measurable objectives the individual will be working on until the next
visit. The Plan also notes when the next engagement with the individual
is
scheduled.
Department - the District of Columbia Department of Human Services or any
successor organizational unit (in whole or in part).
Department of Health Care Finance - the District of Columbia state Medicaid
agency.
Director - the Director of the Department.
Disability- as defined at 42 U.S.C. § 416(i).
Disabling condition - an injury, substance use disorder, mental health condition,
or illness, as diagnosed by a qualified health professional, that
is expected
to cause an extended or long-term incapacitation but does not meet the
definition
of disability in, as defined at 42 U.S.C. § 416(i).
Governing authority - the designated individuals or body legally responsible for
conducting the affairs
of the HSS Provider.
Grievance - a description by any individual of his or her dissatisfaction with an
HSS provider, including the denial or abuse
of any consumer right or
protection provided by applicable Federal and District laws and regulations.
Homeless Management Information System - the District's information
technology system used
to collect client-level data and data on the provision
33 of housing and services to homeless individuals and families and persons at
risk
of homelessness.
Homeless Outreach Provider Team -an organization contracted by the
Department
to engage individuals who are living on the streets and are
experiencing homelessness. Outreach efforts connect vulnerable
individuals to housing resources within the Coordinated Entry System
Household -a home dwelling and its occupants.
Housing navigation -using a Housing First approach, Housing Navigation
assistance offered by the Provider is designed
to identify and secure housing
for consumers
as quickly as possible, by implementing activities such as:
active recruitment and retaining of landlords and housing managers willing
to rent
to consumers (who may otherwise fail to pass typical tenant
screening criteria); housing unit search and identification; helping
consumers gather documents needed for housing placement; completing
the housing and subsidy application process; and moving and securing basic
housing needs. The Housing Navigation assistance offered by the PSHP
Provider to all consumers, needs to be consistent with the consumer's needs
and preferences (within the limits
of their income combined with available
subsidy), taking into consideration safety and access
to transportation,
connection to health care, treatment, school, daycare and support systems,
and employment opportunities.
Housing stabilization -services and actions designed to help households at risk
of becoming homeless to keep housing.
Housing Supportive Services -housing-related activities and services that support
a person's ability to prepare for and transition
to housing, and services that
support a person in continuing successful tenancy in their housing unit.
Housing unit - a single room occupancy room/facility, individual apartment,
townhome, or single-family home utilized to house consumers in HSS.
Housing units for families have separate cooking facilities and other basic
necessities
to enable families to prepare and consume meals; bathroom
facilities for the use
of the family; and separate sleeping quarters for adults
and minor children in accordance with the occupancy standards
of Title 14
of the DCMR. Housing units can be project-based or tenant-based.
HSS Provider -the individual, organization, or corporation, public or private, that
provides HSS services, meets the qualifications set forth in this Chapter and
seeks reimbursement for providing those services under the Medicaid
program. An HSS provider
is a provider as defined under Section 2(30) of
the Act and an HSS agency as defined at 29 DCMR 10399.
34 Human Care Agreement - a written agreement for the procurement of education
or special education, health, human, or social services pursuant
to D.C.
Official Code § 2-354.06, to be provided directly to persons who are
disabled, disadvantaged, displaced, elderly, indigent, mentally or physically
ill, unemployed, or minors in the custody
of the District of Columbia.
Individual - a person eligible to receive HSS as set forth in this Chapter.
Individual Service Plan - a written agreement between the individual and the HSS
provider describing the results
of the person-centered planning process
addressing the strengths, preferences, needs and dreams
as described by the
person. The plan consists
of time-specific goals and objectives designed to
promote self-sufficiency and attainment
of permanent housing. These goals
and objectives are based on the consumer's assessed needs, desires,
strengths, resources, and limitations.
Key personnel - the essential staff required to implement and execute the scope of
work in the HSS Provider's Human Care Agreement.
Linkage -when a Provider connects or joins a consumer with a needed service or
support. This could include, but
is not limited to, communicating on behalf
of the consumer to the service, providing the consumer contact information
or completing needed applications or paperwork. The Provider must first
ensure the service or support
is current and viable.
Medicaid - the medical assistance program approved by federal Centers for
Medicare and Medicaid Services and administered by DHCF, which
enables the District
to receive federal financial assistance for its medical
assistance program and other purposes as permitted by law.
Organizational onboarding - the mechanism through which new employees
acquire the necessary knowledge, skills, and behaviors to become effective
performers. It begins with recruitment and includes a series
of events, one
of which is employee orientation, which helps new employees understand
performance expectations and contribute
to the success of the organization.
Outreach and engagement - describes the processes used to find/locate a
consumer, establish contact with them ( outreach) and build a long-lasting,
trusting connection with the individual services Provider ( engagement).
Outreach and engagement practices are targeted, proactive, and client
centered, with particular attention given to finding and engaging with
persons in crisis, who may be initially reluctant to accept assistance.
Quality control- an HSS Provider's internal system for monitoring and improving
delivery
of services and internal operations.
35 Self-sufficiency - the ability to provide for one's own social and economic needs
with little
to no assistance from others.
Supplemental Nutrition Assistance Program - formerly known as the Food
Stamp program, SNAP provides food-purchasing assistance to District
residents with low-or no-income.
Supportive Services - an array of medical, behavioral health, substance use,
educational, social services, employment, life skills, and financial services
aimed at enabling housing placement, housing stability, health, wellness,
community integration, self-sufficiency, and the improved quality
of life of
an individual.
Chapter 25, SHELTER AND SUPPORTIVE HOUSING FOR INDIVIDUALS AND
FAMILIES,
of Title 29 DCMR, is amended as follows:
A new section 2574, REIMBURSEMENT FOR PSH SUPPORTIVE SERVICES,
is added to
read as follows:
2574
2574.1
2574.2
2574.3
REIMBURSEMENT FOR PSH SUPPORTIVE SERVICES
The Department shall reimburse PSH providers, using per member per month
(PMPM) rate structure, for the provision
of PSH services to adult participants that
are not eligible for enrollment in the District's Medicaid Housing Supportive
Services (HSS) program, or that temporarily lose their DC Medicaid enrollment
status. The PMPM rate paid by the Department shall equal the rate described at 29
DCMR § 7420.2.
The Department shall also reimburse PSH providers for the provision
of adjunct
services that facilitate the provision
of PSH and promote the housing stability of
adult participants on a monthly basis. The reimbursement rates for each type of
service are detailed below or in the Department's HCA with the PSH provider:
(a) Services provided to minors in an adult participant's household, at a rate of
$400.00 per household, per month;
(b) Utility assistance;
(
c) Financial assistance; and
(
d) Staff onboarding.
In order to be eligible for a PMPM payment for PSH services, a PSH provider shall
deliver a minimum
of two (2) PSH services to an eligible adult client within a
month.
36 2574.4
2574.5 To receive a monthly household payment for PSH services delivered to minors in
the adult individual's household, the HSS provider shall provide services at the
scope and frequency described in the HSS provider's HCA with the Department.
The following services are not covered
as PSH services:
(a) Room and board residential costs;
(b) Inpatient hospital services, including hospital, nursing facility, intermediate
care facility for individuals with intellectual disabilities, and institutions for
mental diseases;
(
c) Prescription drug costs;
(
d) Transportation services;
(e) Educational, vocational, and job training services;
(f) Services rendered by parents or other family members;
(g) Social or recreational services;
(h) Services that are not provided and documented in accordance with these
certification standards; and
(i) Services furnished
to persons other than the client or client's household
members when those services are not directed primarily
to the well-being
and benefit
of the individual.
37