District of Columbia - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The District of Columbia Department of Health Care Finance (DHCF) and the Department on Disability Services (DDS) authorize Respite Care Services under the Elderly and Persons with Physical Disabilities (EPD) Waiver and the ID/DD Waiver to provide temporary relief for unpaid primary caregivers. The service is strictly capped at 720 hours or 30 days per individual per calendar year, with any overage requiring explicit documented approval from the state.

Prospective providers cannot simply submit a Medicaid enrollment application; they must first submit a formal Letter of Intent (LOI) to the Long Term Care Administration (LTCA) or DDS and attend a mandatory Prospective Providers Meeting. Facility-based respite providers must also secure licensure under the Health Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983 before delivering services.

1. Service Definition and Scope

Respite Care Services in the District of Columbia provide short-term relief to an unpaid primary caregiver, ensuring the waiver participant continues to receive necessary supervision and support. Services can be delivered in the individual's home or in an approved facility setting.

The scope of the service is strictly defined by annual utilization limits to ensure it remains a temporary relief measure rather than a permanent care solution.

• Service Limit: Capped at 720 hours or 30 days per individual, per calendar year.
• Overage Approval: Exceeding the 720-hour limit requires explicit documented approval from DHCF.
• Target Population: Individuals enrolled in the EPD Waiver or the ID/DD Waiver requiring continuous care.
• Delivery Settings: Can be provided in the person's residence or an approved, Medicaid-enrolled facility meeting HCBS setting requirements.

2. Regulatory and Oversight Agencies

Multiple District agencies coordinate to oversee HCBS waivers, license facilities, and enroll providers. The Department of Health Care Finance (DHCF) serves as the single state Medicaid agency, while the Department on Disability Services (DDS) manages the ID/DD waiver operations.

DHCF utilizes a contracted vendor to manage the physical site inspections and enrollment portal operations for waiver providers.

• Department of Health Care Finance (DHCF): Administers the Medicaid program and EPD Waiver (https://dhcf.dc.gov).
• Department on Disability Services (DDS): Oversees the ID/DD Waiver through its Developmental Disabilities Administration (https://dds.dc.gov).
• Long Term Care Administration (LTCA): Division within DHCF that manages EPD provider enrollment and LOI submissions (https://dhcf.dc.gov/page/becoming-epd-waiver-provider).
• Maximus: DHCF's contracted Provider Enrollment vendor responsible for conducting pre- and post-enrollment site visits (https://www.dcpdms.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

The District of Columbia strictly controls the intake of new HCBS waiver providers through a mandatory Letter of Intent (LOI) and orientation process. Applications submitted without completing these preliminary steps are rejected.

Additionally, providers seeking to serve the ID/DD population must meet specific historical experience requirements if they do not already hold long-term certification in the District.

• Letter of Intent (EPD Waiver): Must be submitted to the LTCA at [email protected] before applying.
• Letter of Intent (ID/DD Waiver): Must be submitted to DDA at [email protected].
• Mandatory Information Session: Prospective providers must attend a formal Prospective Providers Meeting coordinated by LTCA or DDS/DDA prior to application submission.
• Experience Requirement (ID/DD): Providers with less than 3 years of Provider Certification Review (PCR) certification must verify at least 1 year of experience providing residential or respite services to the ID/DD population.

4. Licensure and Certification Requirements

While in-home respite may be provided by licensed Home Care Agencies, facility-based respite requires specific residential licensure. Providers must maintain compliance with District municipal regulations and federal HCBS settings rules.

Ongoing certification is managed through the District's Provider Certification Review (PCR) process, which evaluates compliance with waiver standards.

• Facility Licensure: Must be licensed pursuant to the Health Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983 (D.C. Official Code §§ 44-501 et seq.).
• Home Care Agency License: Required for agencies providing personal care and in-home respite services.
• HCBS Settings Rule: Facility-based respite locations must meet all federal HCBS setting requirements to ensure community integration.
• Provider Certification Review (PCR): ID/DD waiver providers must undergo and maintain PCR certification through DDS.

5. Medicaid Provider Enrollment

After clearing the LOI and orientation gates, providers apply through the District's Provider Data Management System (PDMS). The process includes rigorous desk reviews and site visits by DHCF's enrollment vendor.

Financial stability is a core component of the enrollment review, requiring a dedicated assessment by District finance officials.

• Enrollment Portal: Applications are processed through the DC Provider Data Management System (https://www.dcpdms.com).
• Application Form: Requires the Home and Community Based Waiver Services Medicaid Provider Enrollment Application.
• Site Visits: Maximus conducts structured pre- and post-enrollment site visits for all prospective and existing EPD waiver providers.
• Financial Viability Assessment: Required component reviewed by DHCF-ORRFA during the enrollment process.

6. Staffing, Training and Background Checks

Respite staff must meet the qualifications appropriate to the level of care required by the waiver participant. Agencies are responsible for verifying credentials and conducting comprehensive background screenings.

Agency leadership is also required to participate in initial training to ensure understanding of District waiver rules.

• Basic Qualifications: Staff must be trained in the specific care needs of the individual as outlined in their support plan.
• Background Checks: Mandatory criminal history and registry checks for all direct support professionals.
• CPR/First Aid: Direct care staff must maintain current certification in CPR and First Aid.
• Key Personnel: Administrators, owners, and quality assurance directors are required to participate in the initial DHCF/LTCA information sessions.

7. Documentation, Policies and Records

Providers must maintain detailed records of service delivery to justify Medicaid billing and comply with Chapter 29-19 of the DC Municipal Regulations. Support plans must be person-centered and regularly updated.

Because respite is strictly capped, timekeeping documentation must be exact to prevent unauthorized overbilling.

• Regulatory Compliance: Must comply with reporting requirements under Section 29-1908 and Section 29-1911 of the DCMR.
• Support Plan: Must use DDS-approved Person-Centered Thinking and Discovery tools to develop a support plan within the first week of service.
• Plan Reviews: Support plans must be reviewed and revised quarterly, or more frequently as needed.
• Service Logs: Must document exact start and stop times to track against the 720-hour annual limit.

8. Billing, Rates and Claims

Respite services are billed to the DC Medicaid program based on established fee schedules. Providers must carefully track utilization to avoid exceeding the strict annual caps without prior authorization.

All services must be tied to an approved Level of Care determination signed by an enrolled Medicaid provider.

• Annual Cap: Billing cannot exceed 720 hours or 30 days per calendar year per participant without explicit DHCF approval.
• Prior Authorization: Services must be authorized via a Prescription Order Form (POF) and an approved Level of Care (LOC) determination.
• Ordering Provider: The clinician completing the LOC form must be an enrolled DC Medicaid provider.
• Claims System: Claims are submitted through the District's MMIS/PDMS infrastructure.

9. Approval Sequence and Timeline

The enrollment process is multi-staged, beginning with the LOI and culminating in a Medicaid Provider Agreement. Timelines vary based on the completeness of the application and the scheduling of mandatory site visits.

Initial reviews by DDA for the ID/DD waiver take approximately 15 business days, but full enrollment through DHCF takes significantly longer.

• Step 1: Submit Letter of Intent to LTCA or DDA.
• Step 2: Attend the mandatory quarterly or ad hoc Prospective Providers Meeting.
• Step 3: Submit the formal Medicaid Provider Enrollment Application via PDMS.
• Step 4: Undergo desk review, Financial Viability Assessment, and Maximus site visits.
• Step 5: Receive approval or denial letter from DHCF.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to skipped prerequisite steps or incomplete documentation. During surveys, exceeding service limits without authorization is a primary compliance issue.

Financial viability failures also block many prospective agencies from completing enrollment.

• Skipped Prerequisites: Denials for submitting an application without first submitting an LOI and attending the mandatory information session.
• Incomplete Financials: Failure to pass the DHCF-ORRFA Financial Viability Assessment.
• Limit Violations: Billing beyond the 720-hour annual cap without documented explicit approval.
• Setting Rule Non-Compliance: Facility-based respite locations failing to meet federal HCBS community integration standards.

11. Key Contacts and Resources

Prospective providers should utilize the official District portals and contact the specific waiver administration divisions for guidance. The PDMS portal is the central hub for enrollment actions.

Email addresses for LOI submissions are specific to the waiver program the provider intends to serve.

• DC Provider Data Management System (PDMS): https://www.dcpdms.com
• DHCF EPD Waiver Provider Page: https://dhcf.dc.gov/page/becoming-epd-waiver-provider
• DDS Provider Enrollment: https://dds.dc.gov
• LTCA LOI Email: [email protected]
• DDA LOI Email: [email protected]

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