District of Columbia - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-09

The District of Columbia Department of Health Care Finance (DHCF) funds one-time community setup expenses through Community Transition Services under the Elderly and Persons with Physical Disabilities (EPD) Waiver and the Individuals with Intellectual and Developmental Disabilities (IDD) Waiver. Prospective providers must first submit a Letter of Intent (LOI) and attend a Mandatory Prospective Provider Information Session before gaining access to the Provider Data Management System (PDMS) application.

Approval requires securing a Basic Business License from the Department of Licensing and Consumer Protection (DLCP) rather than a clinical health license from DC Health, as this service focuses on administrative coordination and purchasing rather than direct patient care. Applicants must pass the Department on Disability Services (DDS) Provider Certification Review (PCR) if serving the IDD population, or DHCF's readiness review for the EPD waiver, before executing a Medicaid Provider Agreement.

1. Service Definition and Scope

Community Transition Services cover non-recurring setup expenses for individuals transitioning from an institutional setting, such as a nursing facility or ICF/IID, to a private community residence. The service caps expenditures per participant and covers essential household items, moving expenses, and utility deposits.

This service does not cover ongoing rent or room and board. It is strictly limited to the logistical and financial hurdles of establishing a basic household in the community.

• Service Name: Community Transition Services (under EPD and IDD Waivers).
• Covered Expenses: Security deposits, utility setup fees, essential furnishings, and moving costs.
• Excluded Costs: Monthly rental payments, ongoing utility charges, and recreational items.
• Funding Cap: Typically capped at $5,000 per participant lifetime under the EPD Waiver.
• Target Population: Medicaid beneficiaries residing in institutions for at least 90 days transitioning to a community setting.

2. Regulatory and Oversight Agencies

Multiple District agencies coordinate to oversee waiver services. DHCF holds ultimate authority as the State Medicaid Agency, while operational oversight is split between DACL and DDS depending on the target population.

Providers must interact with different agencies for business licensure, waiver certification, and claims processing.

• State Medicaid Agency: Department of Health Care Finance (DHCF) [https://dhcf.dc.gov].
• EPD Waiver Operator: Department of Aging and Community Living (DACL) [https://dacl.dc.gov].
• IDD Waiver Operator: Department on Disability Services (DDS) [https://dds.dc.gov].
• Business Licensing: Department of Licensing and Consumer Protection (DLCP) [https://dlcp.dc.gov].
• Medicaid Enrollment Portal: Provider Data Management System (PDMS) [https://www.dcpdms.com].

3. Gatekeeping Prerequisites: Who Can Even Apply

The District of Columbia imposes strict entry gates before a provider can submit a formal Medicaid enrollment application. The mandatory Letter of Intent (LOI) and Information Session requirement for EPD waiver providers dictates when and if an application can be initiated.

Providers cannot simply create an account and apply; they must be invited to the PDMS system after clearing these initial administrative hurdles.

• Mandatory Information Session: EPD applicants must attend a DHCF Prospective Provider Information Session before applying.
• Letter of Intent (LOI): Required submission to DHCF prior to receiving an invitation to apply via PDMS.
• DDS Provider Certification Review (PCR): IDD waiver applicants must pass an initial PCR readiness review by DDS before Medicaid enrollment.
• Business Registration: Must possess a DC Certificate of Authority and a Basic Business License from DLCP prior to application.
• NPI Requirement: Must obtain a National Provider Identifier (NPI) registered to the exact business entity applying.

4. Licensure and Certification Requirements

Because Community Transition Services do not involve direct clinical care, DC Health does not issue a specific health facility license for this provider type. Instead, providers must maintain standard corporate licensure and pass waiver-specific certification reviews.

Out-of-state entities must ensure they are properly registered to conduct business within the District boundaries.

• Health Licensure: Not required by DC Health (HRLA) for standalone transition services.
• Corporate Licensure: Basic Business License (BBL) issued by DLCP.
• Foreign Entity Registration: Out-of-state providers must obtain a Certificate of Authority to operate in DC.
• DDS Certification: IDD providers must achieve and maintain Provider Certification Review (PCR) approval.
• Insurance Minimums: $1,000,000 per occurrence and $3,000,000 aggregate liability coverage required.

5. Medicaid Provider Enrollment

Enrollment is processed through the Maximus-operated Provider Data Management System (PDMS). Providers have a strict 90-day window to complete their application in PDMS once invited after the LOI stage.

Failure to submit all required ownership disclosures and agreements within this window results in the application being purged.

• Enrollment System: Provider Data Management System (PDMS) [https://www.dcpdms.com].
• Application Window: 90 days to submit the application in PDMS after DHCF approval of the LOI.
• Required Forms: Disclosure of Ownership and Control Interest Statement, IRS Form W-9, and Medicaid Provider Agreement.
• Application Fee: Subject to the ACA institutional provider application fee (unless waived by Medicare/other state enrollment).
• Revalidation: Required every three to five years depending on the specific waiver and DHCF schedule.

6. Staffing, Training and Background Checks

Staff coordinating transition services must meet baseline Medicaid screening requirements. While clinical degrees are not required, personnel must pass strict background checks and complete mandatory waiver training.

Training focuses on person-centered planning and community integration principles.

• Background Checks: Federal and District criminal background checks required for all staff interacting with participants.
• Exclusion Screening: Mandatory monthly checks against OIG LEIE and SAM.gov databases.
• Mandatory Training: Staff must complete Person-Centered Thinking and Supported Community Integration training as determined by DHCF/DDS.
• CPR/First Aid: Required for staff conducting in-person community visits with waiver participants.
• Qualifications: High school diploma or GED and demonstrated experience in community resource navigation.

7. Documentation, Policies and Records

Providers must maintain auditable records of all transition expenditures. Because this service reimburses physical goods and deposits, financial documentation is scrutinized heavily during audits.

Every purchased item must tie directly back to the participant's approved service plan.

• Receipt Retention: Original receipts for all purchased goods, deposits, and moving expenses must be retained for at least six years.
• Transition Plan: Purchases must be explicitly authorized in the participant's Person-Centered Service Plan (PCSP).
• Inventory Log: Providers must maintain a log of all household items purchased and delivered to the participant's home.
• Policy Manual: Must include policies on fraud, waste, and abuse, and participant rights.
• Binder Submission: Initial DDS applications often require policies submitted in a structured three-ring binder format or specific electronic equivalent.

8. Billing, Rates and Claims

Community Transition Services are billed as a one-time or milestone-based service rather than an hourly rate. Claims are processed through the DC Medicaid Management Information System (MMIS).

Providers are reimbursed for actual costs incurred up to the authorized limit, rather than a flat fee.

• Billing System: DC MMIS for claims submission and remittance.
• Procedure Code: Typically billed under T2038 (Community Transition, waiver) depending on the specific waiver appendix.
• Reimbursement Structure: Reimbursed based on actual authorized expenses up to the waiver cap (e.g., $5,000).
• Prior Authorization: 100% of transition expenses require prior authorization from the waiver case manager/service coordinator.
• Payer of Last Resort: Medicaid only pays if no other community resources (e.g., housing vouchers) cover the specific expense.

9. Approval Sequence and Timeline

The end-to-end approval process in DC is lengthy due to the multi-step LOI and readiness review phases. Providers should expect a minimum of four to six months from initial interest to final Medicaid enrollment.

Delays in obtaining the Basic Business License or passing the PCR will extend this timeline significantly.

• Step 1: Submit Expression of Interest and attend Mandatory Information Session (Month 1).
• Step 2: Submit Letter of Intent (LOI) to DHCF (Month 1-2).
• Step 3: Receive invitation and submit PDMS application within 90 days (Month 2-4).
• Step 4: Undergo DHCF/DDS readiness review and policy evaluation (Month 4-5).
• Step 5: Receive approval letter and execute Medicaid Provider Agreement (Month 5-6).

10. Common Denials and Survey Findings

Applications are frequently rejected at the LOI stage if the provider fails to demonstrate an understanding of the DC waiver structure. Post-enrollment, audits often penalize providers for missing financial documentation.

Strict adherence to the 90-day PDMS window is critical to avoid application abandonment.

• LOI Rejection: Failure to attend the mandatory information session prior to LOI submission.
• PDMS Timeout: Missing the 90-day window to complete the application in PDMS.
• Unapproved Purchases: Billing for items not explicitly listed in the approved Person-Centered Service Plan.
• Missing Receipts: Failure to produce original vendor receipts for furniture or deposits during DHCF audits.
• Insurance Deficiencies: Lapsing on the $1M/$3M liability insurance requirement.

11. Key Contacts and Resources

Providers must utilize official DC government portals for all enrollment and regulatory activities. The primary points of contact are DHCF for enrollment and DDS/DACL for waiver operations.

Always refer to the latest provider bulletins on the DHCF website for updates to the LOI process.

• DHCF Provider Enrollment: [https://dhcf.dc.gov/page/provider-enrollment]
• Provider Data Management System (PDMS): [https://www.dcpdms.com]
• Department on Disability Services (DDS): [https://dds.dc.gov]
• Department of Aging and Community Living (DACL): [https://dacl.dc.gov]
• Department of Licensing and Consumer Protection (DLCP): [https://dlcp.dc.gov]

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