D.C. Law 25-142. Home Visiting Services Reimbursement Amendment Act of 2024.
AN ACT
To amend title I of the Birth-to-Three for All DC Amendment Act of 2018 to extend health insurance coverage for eligible home visiting services through Medicaid, DC HealthCare Alliance, and the Immigrant Children's Program.
BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act may be cited as the "Home Visiting Services Reimbursement Amendment Act of 2024".
Sec. 2. Title I of the Birth-to-Three for All DC Amendment Act of 2018, effective October 30, 2018 (D.C. Law 22-179; D.C. Official Code § 4-651.01 et seq.), is amended by adding a new section 111 to read as follows:
"Sec. 111. Reimbursement for home visiting services.
"(a) By January 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 December 31, 2024, 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) 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) 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; and
"(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.".
Sec. 3. Applicability.
(a) This act shall apply upon the date of inclusion of its fiscal effect in an approved budget and financial plan.
(b) The Chief Financial Officer shall certify the date of the inclusion of the fiscal effect in an approved budget and financial plan, and provide notice to the Budget Director of the Council of the certification.
(c)(1) The Budget Director shall cause the notice of the certification to be published in the District of Columbia Register.
(2) The date of publication of the notice of the certification shall not affect the applicability of this act.
Sec. 4. Fiscal impact statement.
The Council adopts the fiscal impact statement in the committee report as the fiscal impact statement required by section 4a of the General Legislative Procedures Act of 1975, approved October 16, 2006 (120 Stat. 2038; D.C. Official Code § 1-301.47a).
Sec. 5. Effective date.
This act shall take effect after approval by the Mayor (or in the event of veto by the Mayor, action by the Council to override the veto), a 30-day period of congressional review as provided in section 602(c)(1) of the District of Columbia Home Rule Act, approved December 24, 1973 (87 Stat. 813; D.C. Official Code § 1-206.02(c)(1)), and publication in the District of Columbia Register.
