11. Reimbursement for home visiting services. (a) By July 1, 2025, health insurance coverage through Medicaid or the DC HealthCare Alliance and the Immigrant Children's Program shall cover and reimburse eligible home visiting services provided by an eligible home visiting program; except, that no Medicaid payment shall be made until such time that CMS approves the Medicaid state plan amendment described in subsection (b) of this section. (b)(1) By March 31, 2025, DHCF shall submit for approval from CMS an amendment to the Medicaid state plan to authorize the Medicaid payments described in this section. (2) While preparing the Medicaid state plan amendment application, DHCF shall: (A) In consultation with organizations providing home visiting services and other relevant entities, establish criteria and processes for billing and reimbursement of eligible home visiting services, including: (i) Establishing coverage and eligibility criteria to include at least the covered population; (ii) Establishing a payment methodology based on monthly payments per individual or family receiving eligible home visiting services so that the payment results in adequate reimbursement; (iii) tion; (ii) Establishing a payment methodology based on monthly payments per individual or family receiving eligible home visiting services so that the payment results in adequate reimbursement; (iii) Developing program support and training for home visitors to facilitate billing; and (iv) Assessing the viability of incentive payments to home visitors whose clients attend postpartum appointments with a medical provider; and (B) In consultation with DOH and other relevant entities, issue rules to determine eligibility for reimbursement by Medicaid, the DC HealthCare Alliance, and the Immigrant Children's Program. (c) For purposes of this section, the term: (1) 'CMS' means the Centers for Medicare & Medicaid Services. (2) 'Covered population' means: (A) First-time expectant parents; and (B) Families, and expectant parents, who have children under the age of 5 and meet 3 or more medical, behavioral, or social risk factors, as determined by DHCF. (3) 'Eligible home visiting program' means a home visiting program that conforms to a home visitation model that has been in existence for at least 3 years and: (A) Is research-based and grounded in relevant empirically based knowledge; (B) s a home visiting program that conforms to a home visitation model that has been in existence for at least 3 years and: (A) Is research-based and grounded in relevant empirically based knowledge; (B) Has demonstrated program-determined outcomes; (C) Is associated with a national organization, institution of higher education, or other organization that has comprehensive home visitation program standards to ensure high quality service delivery and continuous program quality improvement; (D) Meets the U.S. Department of Health and Human Services' criteria for evidence of effectiveness as determined by a Home Visiting Evidence of Effectiveness review or meets substantially equivalent criteria for evidence of effectiveness as determined by a credible, independent academic or research organization; and (E) Employs registered nurses as home visitors. (Oct. 30, 2018, D.C. Law 22-179, § 111; as added Mar. 23, 2024, D.C. Law 25-142, § 2, 71 DCR 1474; Sept. 18, 2024, D.C. Law 25-217, § 5222, 71 DCR 9990.) Applicability Section 5223 of D.C. Law 25-217 repealed section 3 of D.C. Law 25-142 removing the applicability provision impacting this section. Sept. 18, 2024, D.C. Law 25-217, § 5222, 71 DCR 9990.) Applicability Section 5223 of D.C. Law 25-217 repealed section 3 of D.C. Law 25-142 removing the applicability provision impacting this section. Therefore the amendment of this section by section 2 of Law 25-142 has been implemented. Section 5223 of D.C. Act 25-506 repealed section 3 of D.C. Law 25-142 removing the applicability provision impacting this section. Therefore the amendment of this section by section 2 of Law 25-142 has been implemented. Applicability of D.C. Law 25-142: § 3 of D.C. Law 25-142 provided that the creation of this section by § 2 of D.C. Law 25-142 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented. Emergency Legislation For temporary (90 days) amendment of this section, see § 5222 of Fiscal Year 2025 Budget Support Emergency Act of 2024 (D.C. Act 25-506, July 15, 2024, 71 DCR 8406).
District of Columbia Legal Code