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Department of Health Care Finance
 

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Long Term Care Administration

The Long Term Care Administration (LTCA) provides oversight and monitoring of programs targeted to elders, persons with physical disabilities, and persons with intellectual and developmental disabilities (ID/DD). Through program development and day-to-day operations, the LTCA also ensures access to needed cost-effective, high quality extended and long-term care services for Medicaid beneficiaries residing in home and community-based or institutional settings.

The LTCA is comprised of three divisions:

Functions/Divisions:

  1. Program Operations – primarily responsible for daily operations to ensure service delivery for both providers and beneficiaries for all long term care services and supports, with the exclusion of the IDD Waiver which is operated by the Department on Disability Services. Program operations also focuses on issue resolution, ensuring timeliness of prior authorizations, provision of training and technical assistance to providers, provider readiness and complaint triage and resolution.
  2. Oversight and Monitoring – primarily responsible for quality assurance of the agency’s long-term care programs (including compliance with six CMS assurances) and outcomes, including compliance with CMS assurances for performance of both waiver programs (ID/DD and EPD). This division also conducts oversight of LTCA providers through audits, site visits, and issuance and review of corrective action plans.
  3. Intake and Assessment – primarily responsible for programmatic eligibility and enrollment into LTCSS. This includes oversight of the LTCSS Contractor, quality assurance of the face-to-face assessment for LTCSS, level of care reviews, IDD acuity level reviews and approvals and participation in the fair hearings and appeals processes.

LTCA Webpage FAQs

  1. What are Long Term Services and Supports? Long term services and supports (LTSS) are a variety of health and social services that offer care for elders and people with disabilities who need support because of their age; physical, mental, growing or long-lasting health conditions that limit their abilities to care for themselves. LTSS can be provided in the home, in a community-based setting, or in a facility. Activities of daily living can include eating, bathing, grooming, dressing, walking, toileting, getting up/down from a seated position, preparing meals, and help with telephone use.
  2. How do I access LTSS? LTSS can be accessed through a network of five District of Columbia Government agencies and non-profit organizations that will take part in person and family-centered planning and offer information about and recommendations for LTSS.  The information will allow people with disabilities, seniors and their families to make choices about the LTSS they need to live with dignity in their homes and be fully included in their communities for as long as possible. The Department of Health Care Finance (https://dhcf.dc.gov/), Department on Disability Services (https://dds.dc.gov/), Department of Behavioral Health (https://dbh.dc.gov/), Department of Human Services (https://dhs.dc.gov/), DC Office on Aging (https://dcoa.dc.gov/) and nonprofit organizations work together to update access to LTSS from different sources. LTSS is related to any person, of any age or need, who is looking for or planning LTSS.
  3. What are the eligibility requirements for LTSS? The eligibility requirements for Long Term Services and Supports (LTSS) are made up of both financial and non-financial eligibility criteria. The non-financial eligibility criteria include demographic information such as age, and disability; U.S. citizenship or other qualified status; D.C. residency status; and level of care eligibility. The level of care eligibility is determined by the receipt of a unique score as determined by DHCF’s face-to-face long term care assessment tool.  The financial eligibility criteria are based on a person’s income and assets. The Department of Human Services’ Economic Security Administration is responsible for checking a person’s financial and non-financial eligibility with the exception of the level of care eligibility. A RN employed by DHCF’s agent decides a person’s level of care eligibility by giving an assessment determination used by the tool that identifies an individual’s level of need for a range of LTSS for which the person is eligible. 
  4. What is Person-Centered Planning? Person-Centered Planning is a person and family-centered approached focused on identifying what is important to and for each person who needs supports (as well as their families) with the goal of allowing people to live in their homes with dignity and be fully included in their communities for as long as possible. 
  5. How do I become a LTSS provider? To become a provider in the Elderly and Persons with Physical Disabilities (EPD) Medicaid Waiver Program, potential providers must submit a complete Provider Enrollment package with all the required documents.  It is DHCF’s job to make sure potential providers have the required knowledge, skills and abilities to successfully deliver services and supports. The provider enrollment process is all-inclusive and is as follows: 

 

Step 1: Provider must submit a “Letter of Intent” (LOI) to the Long Term Care Administration (LTCA) at dhcf.epdproviderenrollment@dc.gov.

The LOI must contain:   

  • Name of agency with proof of incorporation in the District of Columbia
  • Contact person with mailing address, business email address and telephone number
  • Brief description of the type of services the prospective provider would like to provide, and;
  • Brief statement of the agency’s readiness to provide the service(s) for which approval is requested. 

The statement must reflect proof of knowledge and understanding of the relationship between State Plan and Waiver services as related to the service provided for which the applicant is seeking approval. 

Step 2: LTCA will accept or deny the LOI within 7 business days of receipt. A member of the LTCA team will respond to potential providers via email requesting a corrected LOI or acknowledging receipt of a complete LOI and the following information on next steps:
1.    Overview of the readiness process
2.    A checklist of required information
3.    Scheduled date for attendance at a mandatory information session

Step 3: The potential provider is required to attend the required provider enrollment information session organized by the LTCA within 90 days of submitting the LOI.  
A.    The meeting will include:
1.     An overview of the Department of Health Care Finance’s mission statement
2.    DHCF’s commitment to Federal assurances and performance goals related to the administration and operations of a Home and Community-Based Waiver Service Program
3.    Overview of the provider enrollment process
B.    The potential provider should coordinate with important individuals involved with the program/service under review to attend this session.
C.    The LTCA will maintain appropriate documentation to confirm attendance of potential providers. 
D.    Mutual understanding between the potential provider and EPD personnel of the readiness review process and the expectations for qualified service providers is the goal of the information session, and questions regarding the process and technical assistance are to be addressed in this forum.

Step 4: The application must be submitted within 90 days of attending the provider enrollment information session with Maximus via www.dcpdms.com, with all requested documents. Maximus will conduct an initial review to ensure all required documents are included and the application is complete, prior to sending the application to DHCF.