Section 22-A3906. REIMBURSEMENT LIMITATIONS

 

3906.1Clubhouse services may be reimbursed for a maximum of four hundred seventy-five (475) units quarterly, per member per fiscal year. 

 

3906.2Clubhouse services may be authorized for a maximum of ninety (90) days at a time, in accordance with the requirements of the IRP and the annual rehabilitation plan.

 

3906.3 Clubhouse services may not be reimbursed for the same consumer on the same day as rehabilitation/day services, intensive day services or assertive community treatment.

 

3906.4 The following services that may not be reimbursed through Medicaid include, but are not limited to:

 

(a) Transportation services;

 

(b) Vocational services;

 

(c) School and educational services;

 

(d) Services rendered by parents or other family members;

 

(a) Socialization services;

 

(f) Screening and prevention services (other than those provided under Early and Periodic Screening, Diagnosis and Treatment requirements);

 

(g) Services which are not medically necessary as recommended in an approved IRP/IPC;

 

(h) Services which are not provided and documented in accordance with these certification standards;

 

(i) Services which are not mental health services; and

 

(j) Services furnished to persons other than the consumer when those services are not directed primarily to the well-being and benefit of the consumer.

 

authority

The Director of the Department of Mental Health (Department), pursuant to the authority set forth in sections 104, and 105 of the Department of Mental Health Establishment Amendment Act of 2001, effective December 18, 2001, (D.C. Law 14-56; D.C. Official Code §§ 7-1131.04 and 7-1131.05).

source

Emergency and Proposed Rulemaking published at 57 DCR 4010 (May 7, 2010)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 57 DCR 7734 (August 20, 2010)[EXPIRED]; as amended by Final Rulemaking published at 57 DCR 8698, 8703 (September 24, 2010).