Section 22-A3424. REIMBURSABLE SERVICES

 

3424.1Reimbursement for the provision of MHRS shall be on a per unit basis as indicated in § 3424.4.

 

3424.2Each covered service shall have a unique billing code as established by DMH.

 

3424.3Units of service reported for part of an hour shall be rounded to the nearest fifteen minute unit.

 

3424.4Reimbursement shall be limited as follows:

 

MHRS	LIMITATIONS AND SERVICE SETTING	BILLABLE UNIT OF SERVICE
Diagnostic/ Assessment	 One (1) every six (6) months  Additional units allowable when pre-authorized for periodic assessment, pre-hospitalization screening, neuropsychological assessment and re-admission to Rehabilitation/Day Services  Shall not be billed the same day as ACT  Provided only in a community-based MIIRS provider or other community setting, or residential facility of sixteen (16) beds or less	An assessment, which is at least three (3) hours in duration
Medication/ Somatic Treatment	 No annual limit  Shall not be billed the same day as ACT  Provided only in a community-based MHRS provider or other community setting, or residential facility of sixteen (16) beds or less	Fifteen (15) minutes
Counseling	 One hundred sixty (160) units per year  Additional units allowable with prior authorization by DMH  Shall not be billed the same day as Rehabilitation/Day Services, Intensive Day Treatment, CBI or ACT  Shall be rendered face-to-face, when consumer is present, unless there is adequate documentation to justify why the consumer was not present during the session  May be provided in individual on-site, individual off- site or group  Provided only in a community-based MHRS provider or other community setting, or residential facility of sixteen (16) beds or less	Fifteen (15) minutes
Community Support	 No annual limits  Shall not be billed on the same day as ACT  May be provided individually or in a group  Provided only in a community-based MHRS provider or other community setting, or residential facility of sixteen (16) beds or less	Fifteen (15) minutes
Crisis/ Emergency	 No annual limits  Provided only in a community-based MHRS provider or other community setting, or residential facility of sixteen (16) beds or less	Fifteen (15) minutes
Rehabilitation/ Day Services	 Ninety (90) days within a twelve (12) month period  Additional units allowable with prior authorization by DMH Shall not be billed on the same day as Counseling  Shall not be billed on the same day as Counseling or ACT  Provided only in a community-based MHRS provider or other community setting, or residential facility of sixteen (16) beds or less	One (1) day (which shall consist of at least three (3) hours)
Intensive Day Treatment	 Seven (7) days  Additional units allowable after seven (7) days or for the second and any additional episodes of care within a twelve (12) month period with prior authorization by DMH  Shall not be billed on the same day as any other MHRS, except for Crisis/Emergency, Community Support and CBI.  Up to three (3) hours of Diagnostic/Assessment may be billed during each episode of Intensive Day Treatment  Provided only in a community-based  MHRS provider -Intensive Day Treatment Facility	One (1) day (which shall consist of at least five (5) hours)
CBI	 Prior authorization from DMH required for enrollment  Shall not be billed on the same day as ACT, Counseling or Intensive Day Treatment  Provided only in a community-based MHRS provider or other community setting, or residential facility of sixteen (16) beds or less	One (1) hour (or part thereof)
Assertive Community Treatment,	 Prior authorization from DMH required for enrollment  Shall not be billed on the same day as any other MHR.S, except for Crisis/Emergency with retrospective authorization	One (1) hour (or part thereof)

 

authority

Section 104 and 114 of the Mental Health Service Delivery Reform Act of 2001, effective December 18, 2001 (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.14 (2001 ed.)).

source

Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); as amended by Final Rulemaking published at 53 DCR 9197 (November 10, 2006).