Section 22-A2515. HEALTH HOME REIMBURSEMENT

 

2515.1The Department shall require all CSAs certified as Health Home providers to enter into an HCA with the Department.  All payment for services shall be implemented through terms and conditions contained in the HCA and the D.C. Medicaid program. 

 

2515.2A CSA also certified as a Health Home may not bill MHRS Community Support for a consumer enrolled in the Health Home.

 

2515.3Reimbursement for Health Home services is on a PMPM rate as published by the Department of Health Care Finance.  The month time period shall begin on the first (1st) of the month and end on the last day of the month.  In order to qualify for the monthly rate, Health Home providers shall provide and document the required services provided during the month for which reimbursement is claimed. 

 

2515.4For a consumer enrolled in a high-acuity band, the Health Home shall provide, at a minimum, and shall document in the consumer’s chart the following services, at least one of which must be provided as a face-to-face service:

 

(a) Two (2) care management services;  and

 

(b) At least two (2) other Health Home services.

 

2515.5For a consumer enrolled in a low-acuity band, the Health Home shall provide at a minimum one (1) care management service and one (1) other Health Home service. 

 

2515.6Only one (1) Health Home will receive payment for delivering Health Home services to a consumer in a particular month.

 

 

authority

Sections 5113, 5115, 5117 and 5118 of the Department of Behavioral Health Establishment Act of 2013, effective December 24, 2013 (D.C. Law 20-61; D.C. Official Code §§ 7-1141.02, 7-1141-04, 7-1141.06 and 7-1141.07 (2012 Repl.)).

source

Final Rulemaking published at 63 DCR 849 (January 22, 2016).