Code of the District of Columbia

Part D. Nursing Facilities Medicaid Reimbursement.


§ 4–204.61. Definitions.

For the purposes of this part, the term:

(1) “Case mix reimbursement methodology” means a prospective Medicaid payment rate system for nursing facilities that includes:

(A) A point-of-sale prescription system;

(B) A resident classification system based on resident acuity and needs; and

(C) The following 3 peer groupings for rate purposes:

(i) All freestanding nursing facilities, except those owned by the District of Columbia;

(ii) All hospital-based nursing facilities; and

(iii) All nursing facilities owned by the District of Columbia.

(2) “Medicaid” means the medical assistance programs authorized by title XIX of the Social Security Act, approved July 30, 1965 (79 Stat. 343; 42 U.S.C. § 1396 et seq.), and by § 1-307.02, and administered by the Department of Health.

(3) “Nursing facility” means a health care facility as defined in § 44-501(a)(3), but does not include a health care facility operated by the federal government.


(Dec. 7, 2004, D.C. Law 15-205, § 5211, 51 DCR 8441; Mar. 2, 2007, D.C. Law 16-191, § 19, 53 DCR 6794.)

Effect of Amendments

D.C. Law 16-191, in par. (3), validated a previously made technical correction.

Emergency Legislation

For temporary (90 day) addition, see § 5211 of Fiscal Year 2005 Budget Support Emergency Act of 2004 (D.C. Act 15-486, August 2, 2004, 51 DCR 8236).

For temporary (90 day) addition, see § 5211 of Fiscal Year 2005 Budget Support Congressional Review Emergency Act of 2004 (D.C. Act 15-594, October 26, 2004, 51 DCR 11725).


§ 4–204.62. Medicaid reimbursement system for nursing facilities.

(a) The Department of Health shall develop and implement a case mix reimbursement methodology for nursing facilities. The case mix reimbursement methodology shall be effective no earlier than April 1, 2005.

(b) The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, shall issue rules to implement this section.


(Dec. 7, 2004, D.C. Law 15-205, § 5212, 51 DCR 8441.)

Section References

This section is referenced in § 47-1269.

Cross References

Child support enforcement, “dependent child” and “public assistance” defined, see § 46-201.

Emergency Legislation

For temporary (90 day) addition, see § 5212 of Fiscal Year 2005 Budget Support Emergency Act of 2004 (D.C. Act 15-486, August 2, 2004, 51 DCR 8236).

For temporary (90 day) addition, see § 5212 of Fiscal Year 2005 Budget Support Congressional Review Emergency Act of 2004 (D.C. Act 15-594, October 26, 2004, 51 DCR 11725).