 |
D.C. Municipal Regulations (Last Updated: September 13, 2017) |
 |
Title 22. HEALTH |
|
SubTilte 22-A. MENTAL HEALTH |
|
Chapter 22-A34. MENTAL HEALTH REHABILITATION SERVICES PROVIDER CERTIFICATION STANDARDS |
Section 22-A3402. SERVICE COVERAGE
-
3402.1MHRS are those rehabilitative or palliative services administered by DMH and rendered by DMH-certified MHRS providers to eligible consumers who require such services.
3402.2MHRS are intended for the maximum reduction of mental disability and restoration of a consumer to his or her best possible functional level.
3402.3MHRS are recommended by a physician or a licensed practitioner of the healing arts (approving qualified practitioners) and rendered by practitioners and clinicians (qualified practitioners) and credentialed staff under the supervision of qualified practitioners, in certified community mental health rehabilitation services agencies (MHRS providers) in accordance with the certification standards established in this chapter.
3402.4Rehabilitative services covered as MHRS are:
(a)Diagnostic/Assessment;
(b)Medication/Somatic Treatment;
(c)Counseling;
(d)Community Support;
(e)Crisis/Emergency;
(f)Rehabilitation/Day Services;
(g)Intensive Day Treatment;
(h)CBI; and
(i)ACT.
3402.5Eligible consumers of MHRS shall meet eligibility requirements established in § 3403.
3402.6Eligible MHRS providers include CSAs, sub-providers and specialty providers that are certified in compliance with the certification standards set forth in this chapter.
3402.7Qualified practitioners rendering MHRS through DMH-certified MHRS providers shall meet eligibility requirements described in § 3413.
3402.8MHRS coverage limitations are set forth in § 3424. Coverage for any MHRS is contingent on whether all of the following criteria are met:
(a)The service shall be medically necessary;
(b)The service shall be delivered by a DMH-certified MHRS provider as described in § 3410, § 3411 and § 3412;
(c)The service shall be delivered by qualified practitioners (and credentialed staff under the supervision of qualified practitioners) acting within their scope of practice as identified in § 3413;
(d)The service shall be delivered in accordance with an approved IRP/IPC as described in § 3407, § 3408 and § 3409; and
(e)The service shall be delivered in accordance with the service specific standards set forth in § 3414, § 3415, § 3416, § 3417, § 3418, § 3419, § 3420, § 3421, § 3422 and § 3423.
3402.9All consumers receiving MHRS shall have free choice of MHRS providers and free choice of qualified practitioners delivering services through a DMH-certified MHRS provider, as described in § 3406.
3402.10All consumers receiving MHRS shall have the right to file a grievance with DMH and shall receive fair hearing rights and notice of such rights in accordance with the requirements set forth in 22-A DCMR Chapter 3.