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Remote Support in the District of Columbia: Every Service It Fits, and How It Is Paid

Any District of Columbia provider agency can get Vista Enterprise™, with VistaLink™ and Vista’s team behind it, and like an EHR or payroll system, it needs no approval. Billing is separate. The Department on Disability Services describes remote supports services in its intellectual and developmental disabilities waiver and its Individual and Family Supports Waiver. Your trained staff respond and decide.

Can any DC agency buy a remote support solution?

Yes. Any provider or agency in the District can get Vista Enterprise™, which includes VistaLink™ and Vista’s team behind the agency. Like an EHR or payroll system, getting it does not need approval from the Department on Disability Services (DDS), the Department of Health Care Finance (DHCF), DC Health, or anyone else.

Billing is a separate question. It depends on the program, the service, your agency’s provider status, and each person’s plan. The rest of this page walks through every place remote support fits in DC.

Where does remote support fit in DC?

Setting or programHow technology is usually paidWhat to know
DDS waivers for people with intellectual and developmental disabilities (IDD)Remote supports versions of five waiver services, billed by the certified provider; equipment through the Assistive Technology service (AT)Clear rules on consent, cameras and backup
EPD waiver (older adults and people with physical disabilities)No remote support service; some equipment through participant-directed goods and servicesCovers personal care and assisted living
ICF/IID (Community Residence Facilities)The facility’s own costFederal staffing floor stays; quality and privacy use
Nursing homes and assisted livingThe facility’s own costPrivacy and fall prevention
Home care agenciesThe agency’s own cost, or the person’s waiver where it appliesFills the gaps between visits
Any agency, any settingAgency gets Vista Enterprise™, with Vista’s team behind itNo approval needed to buy

What are DC’s waiver rules for remote supports?

DDS runs DC’s home and community-based services (HCBS) waivers for people with intellectual and developmental disabilities (IDD): the IDD Waiver and the Individual and Family Supports (IFS) Waiver. DC does not treat remote supports as one stand-alone service. Instead, several waiver services can be delivered remotely:

  • Day Habilitation
  • Employment Readiness
  • Supported Employment
  • In-Home Supports
  • Supported Living (described for the IDD Waiver)

These are DDS’s own program rules for the services it pays for, not VistaLink™ features; your agency confirms its own setup meets them.

In plain words, DDS’s service descriptions say:

  • Live two-way communication. Remote staff of a certified provider connect with the person through equipment that allows live two-way communication.
  • Equipment comes through AT. Equipment rental/purchase goes through the Assistive Technology service (AT), not the remote service itself.
  • Video cameras/monitors only in common areas. Video cameras or monitors are permitted only in common areas, will not be installed in the bathrooms or bedrooms, and will not be used for assistance with dressing or personal hygiene.
  • Four delivery models. Active Support, real time oversight during scheduled times; On Demand Active Support, real time oversight only when needed, typically started by a triggering event from a sensor; Scheduled Check-In; and Drop In, when a remote caregiver checks in at random times.
  • Assessed first. The support team uses DDS’s Assessing Interest in Remote Supports and Technology tool to decide how many hours of remote support fit the person.
  • Part remote, part in person. Services can mix both, and remote support must not isolate the person from the community.

Supported Living with remote supports

Supported Living has the most detailed rules:

  • A qualified technology assessment. The person is assessed by a SHIFT Certified Enabling Technology Integration Specialist (ETIS) employed by a DDS provider.
  • Real-time, awake staff. Supported Living remote supports are provided in real time, not via a recording, by awake staff at a Monitoring Base, and the remote support staff have no duties other than remote support while providing it.
  • Small homes. Supported Living remote supports can be provided in homes of one, two or three people that meet the federal HCBS settings rule.
  • Backup. The Remote Support Vendor keeps a backup power system at the monitoring base and a backup on-call support person who comes in person when needed, within the time DDS sets.
  • Set packages. DDS describes overnight and day packages that combine set hours of remote and in-person support.

What about older adults and people with physical disabilities in DC?

Remote support is not only for disability services. DHCF runs the Elderly and Persons with Physical Disabilities (EPD) waiver. DHCF’s EPD Waiver Services page (checked Oct 25, 2026) lists case management, personal care aide (PCA) services, respite, homemaker, chore aide, assisted living, environmental accessibility adaptations, adult day health, occupational and physical therapy, community transition services, and participant-directed services (Services My Way).

The EPD waiver does not include a remote support service. Agencies that serve EPD participants, including home care and assisted living providers, can still get Vista Enterprise™ for their own staff, with Vista’s team behind them. Under Services My Way, individual-directed goods and services can cover equipment not otherwise provided through the waiver or State Plan, when it meets a need in the person’s plan and decreases the need for other Medicaid services, promotes inclusion in the community, or increases safety in the home, per the same DHCF page.

What has to happen before remote support starts in DC?

  1. The person chooses it. Remote support must fit what is important to and for the person, as written in their Individual Support Plan (ISP).
  2. Assessment. The support team uses the Assessing Interest in Remote Supports and Technology tool, plus an ETIS assessment for Supported Living.
  3. Placement that respects privacy. Video cameras or monitors, if used at all, are permitted only in common areas.
  4. Backup and emergency plans. On-call staff and backup systems are in place before go-live.

How does DC pay for remote support?

DC has several paths, and they work together.

1. Remote supports inside waiver services. A DDS-certified provider bills Day Habilitation, Employment Readiness, Supported Employment, In-Home Supports or Supported Living delivered remotely, in 15-minute units under each service’s rules. Rates are set by DDS. Supported Employment delivered remotely is paid at the same rate as in person.

2. Equipment through the person’s plan. The equipment used for remote supports is rented or bought through the Assistive Technology service (AT), based on the person’s assessed need.

3. Folded into Supported Living. For Supported Living, remote supports are delivered by the Supported Living provider itself, in set combinations of remote and in-person hours. This is DC’s version of remote support built into a residential service.

4. Your agency gets Vista Enterprise™, with Vista’s team behind it. Any agency can get Vista Enterprise™ as its own remote support solution, paid from its own budget, whether or not it bills a waiver service. This is how ICFs, nursing homes, assisted living and home care agencies use it.

What if our staffing stays the same, as in an ICF or a fully staffed group home?

Many DC agencies keep every in-person shift and still use remote support, because technology raises quality even with full staff.

It holds in every setting, since even a fully staffed overnight shift cannot be in every room at once, stay fully alert through every hour of the night, or carry every detail from one shift to the next, and when nothing answers those human limits, they quietly become limits on the outcomes people supported can reach.

That is a limit of people, not a failing of staff.

Enabling technology for human services fills those gaps without replacing anyone, giving trained people better information and more of their time for the moments that need a person in the room.

  • Fewer night bed checks that wake people up. For people who do not need repositioning, in-person checks through the night interrupt sleep and privacy. Staff go in when it matters, because non-wearable sensors let overnight staff know when something needs a person.
  • Closing gaps in data. A steady record across shifts, so handoffs rest on more than memory.
  • Closing gaps in judgment. Even with staff in the building, a change can be easy to miss or hard to read in the middle of the night. A clear record helps staff make the call.

Know the limits.

  • Federal ICF rules set the staffing floor. In an intermediate care facility for individuals with intellectual disabilities (ICF/IID), federal rules require a responsible direct care staff person on duty around the clock when people are present, awake in some living units, plus minimum direct care staff ratios. Remote support adds to on-site staff; it does not replace them.
  • Privacy comes first. Federal rules require ICFs to give each person the opportunity for personal privacy. Federal survey guidance limits cameras and audio in ICFs to common areas, never bedrooms or bathrooms, and says they cannot be used in place of staff. Non-wearable sensors in the home fit that approach.
  • The facility pays. An ICF/IID is paid as a facility, not through a person’s waiver plan, so an ICF that uses Vista Enterprise™ pays for it as its own operating cost.
  • DC’s ICFs are small homes. DC Health licenses ICF/IID homes as Community Residence Facilities for Persons with Intellectual Disabilities, for four to eight people, under Chapter 35 of Title 22-B of the DC rules. DHCF has not enrolled new ICF/IID providers since June 1, 2018, so most growth is in waiver services.

Can nursing homes and assisted living in DC use remote support?

Yes. Nursing homes and assisted living communities get Vista Enterprise™ the same way any agency does, with Vista’s team behind them, and their own staff respond and decide.

  • Nursing homes. Federal rules give each resident a right to personal privacy and require the facility to provide adequate supervision and devices to prevent accidents. Technology that helps staff see who needs them, without waking everyone, supports both goals. Nursing homes are paid as facilities, so Vista Enterprise™ is the facility’s own purchase. In-person staffing rules do not change.
  • Assisted living. Assisted living residents live in their own units, with their own rights to privacy and choice. Technology placed with each resident’s consent gives staff better information between scheduled visits.
  • In DC, assisted living residences are licensed under Chapter 101 of Title 22-B. Residences that take EPD waiver participants also follow the EPD waiver rules, including the federal HCBS settings rule on privacy, dignity and respect.

How does remote support help home care agencies in DC?

Home care agencies send aides into people’s homes for set hours. Between visits, no one is there. Remote support fills that gap: the person keeps their privacy, and the agency’s trained staff can see when something needs attention and decide who should go.

  • Better visits. Aides arrive knowing how the night went.
  • Earlier warning. Changes in routine show up before they become a crisis.
  • Support for family caregivers, who can rest knowing someone trained will respond.
  • In DC, home care agencies are licensed by DC Health under Chapter 39 of Title 22-B. Medicaid personal care aide (PCA) services can be combined on the same day with DDS In-Home Supports, as long as they are not provided at the same time.

Who else can remote support help in DC?

Remote support is enabling technology for human services as a whole, and it works for people with intellectual and developmental disabilities (IDD), older adults, people with physical disabilities, people recovering from an illness or injury, and the staff and families who support them.

How does VistaLink™ fit DC’s rules?

VistaLink™ uses non-wearable sensors and a display in the home to send events to your agency’s own trained remote support staff, and it never acts alone.

Your agency stays the provider. It confirms that its full setup meets DC’s rules for the service it bills, or for its license if it bills nothing. Vista runs implementation and staff onboarding with your team. For Supported Living, your agency keeps the required ETIS assessment, backup power and on-call plan.

For states and government agencies

Vista can also work directly with the District of Columbia’s Department on Disability Services (DDS), and with other state and government agencies, for example through a procurement, a contract or a state-mandated program. The District can adopt Vista Enterprise™ as its District-wide remote support solution, with one solution across providers and Vista’s team behind every agency, while any single agency can already get it with no state approval.

Remote support for states and government agencies

What does remote support look like for a DC agency? (composite example)

This is a composite example built from common situations. It is not a real person.

Two housemates in a Supported Living home want their evenings and nights to themselves. Each is assessed, and each chooses a mix of in-person evening support and remote overnight support. Sensors go in the hallway and kitchen; no cameras are used. Overnight, the agency’s remote staff respond to events and call the on-call staff member when a plan says to.

Questions and answers

Can any DC agency buy a remote support solution?

Yes. Any provider or agency in the District can get Vista Enterprise™, which includes VistaLink™ and Vista’s team behind the agency. Like an EHR, it needs no DDS, DHCF or DC Health approval. Billing follows each program’s rules.

Which DC waiver services can be delivered remotely?

Under DDS’s remote supports service descriptions, Day Habilitation, Employment Readiness, Supported Employment, In-Home Supports and Supported Living can be delivered as remote supports for people in DDS waivers.

Are cameras allowed for remote supports in DC?

Only in common areas. DDS says video cameras or monitors will not be installed in the bathrooms or bedrooms and will not be used for assistance with dressing or personal hygiene. Non-wearable sensors are another option.

How is remote support equipment paid for in DC?

Equipment used for remote supports is rented or bought through the Assistive Technology service (AT), based on the person’s assessed need. The remote service itself is billed by the certified provider.

Who can provide Supported Living remote supports in DC?

A DDS Supported Living provider that meets the remote supports rule, including an assessment by a SHIFT Certified Enabling Technology Integration Specialist employed by a DDS provider, awake real-time staff, backup power and on-call in-person support.

Does the DC EPD waiver pay for remote support?

The EPD waiver does not include a remote support service. Agencies that serve EPD participants, including home care and assisted living providers, can still get Vista Enterprise™ for their own staff, with Vista’s team behind them.

Can a DC ICF, nursing home or assisted living residence use remote support?

Yes, as its own tool alongside on-site staff. Federal staffing rules still apply in full, cameras stay out of private spaces, and the facility pays for Vista Enterprise™ as its own cost.

Is remote support in DC only for disability services?

No. It fits any human service where staff cannot be everywhere at once: disability services, older adults, assisted living, nursing homes and home care.

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