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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-52. MEDICAID REIMBURSEMENT FOR MENTAL HEALTH REHABILITATIVE SERVICES |
Section 29-5213. REIMBURSEMENT
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5213.1 Medicaid reimbursement for Mental Health Rehabilitative Services (MHRS) provided to consumers, other than consumers who are deaf or hearing-impaired, shall be determined as follows:
SERVICE
CODE
BILLABLE UNIT
OF SERVICE
RATE
Diagnostic/
Assessment
T1023HE
An assessment,
at least 3 hours in duration
$256.02
H0002
An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program
$85.34
Medication Training& Support
H0034
15 minutes
$44.65 – Individual
H0034HQ
15 minutes
$13.52 – Group
Counseling
H0004
15 minutes
$26.42 – Individual
H0004HQ
15 minutes
$8.00 – Group
H0004HR
15 minutes
$26.42 – Family with Consumer
On-Site
H0004HS
15 minutes
$26.42 – Family without Consumer On-Site
H0004HETN
15 minutes
$27.45 – Individual Off-Site
Community Support
H0036
15 minutes
$21.97 – Individual
H0036HQ
15 minutes
$6.65 – Group
H0036UK
15 minutes
$21.97 – Collateral
H0036AM
15 minutes
$21.97 – Physician Team Member
H0038
H0038HQ
H0038HS
H0038HQHS
H0036HR
H0036HS
H0036U1
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
$21.97 – Self-Help Peer Support
$6.65 –Self-Help Peer Support Group
$21.97 – Family/Couple Peer Support without Consumer
$6.65 – Family/Couple Peer
Support
Group Without Consumer
$21.97 – Family with Consumer
$21.97 – Family without Consumer
$21.97– Community Residence
Facility
H2023
15 minutes
$18.61– Supported Employment (Therapeutic)
Crisis/
Emergency
H2011
15 minutes
$36.93
Day Services
H0025
One day, at least 3 hours in duration
$116.90
Intensive Day Treatment
H2012
One day, at least 5 hours in duration
$164.61
Community-Based Intervention (Level I – Multi-Systemic Therapy)
H2033
15 minutes
$57.42
Community-Based Intervention (Level II and Level III)
H2022
15 minutes
$35.74
Community-Based Intervention (Level IV – Functional Family Therapy)
H2033HU
15 minutes
$57.42
Assertive Community
Treatment
H0039
15 minutes
$38.04 – Individual
H0039HQ
15 minutes
$11.51 – Group
Trauma Focused Cognitive Behavioral Therapy
H004ST
15 minutes
$35.74
Child-Parent Psychotherapy for Family Violence
H004HT
15 minutes
$35.74
5213.2 Medicaid reimbursement for MHRS provided to consumers who are deaf or hearing-impaired shall be determined as follows:
SERVICE
CODE
BILLABLE UNIT
OF SERVICE
RATE
Diagnostic/
Assessment
T1023HEHK
An assessment,
at least 3 hours in duration
$345.63
H0002HK
An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program
$115.21
Medication Training& Support
H0034HK
15 minutes
$60.28 – Individual
H0034HQHK
15 minutes
$18.25 – Group
Counseling
H0004HK
15 minutes
$35.67 – Individual
H0004HQHK
15 minutes
$10.80 – Group
H0004HRHK
15 minutes
$35.67 – Family with Consumer
On-Site
H0004HSHK
15 minutes
$35.67 – Family without Consumer On-Site
Community Support
H0036HK
15 minutes
$29.66 – Individual
H0036HQHK
15 minutes
$8.98 – Group
H0036UKHK
15 minutes
$29.66 – Collateral
H0036AMHK
15 minutes
$29.66 – Physician Team Member
H0038HK
H0038HQHK
H0038HSHK
H0038HQHK
H0036HRHK
H0036HSHK
H0036U1HK
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
$29.66 – Self-Help Peer Support
$8.98 –Self-Help Peer Support Group
$29.66 – Family/Couple Peer Support without Consumer
$8.98 – Family/Couple Peer Support
Group Without Consumer
$29.66 – Family with Consumer
$29.66 – Family without Consumer
$29.66– Community Residence Facility
H2023HK
15 minutes
$25.12 Supported Employment (Therapeutic)
Crisis/
Emergency
H2011HK
15 minutes
$49.85
Day Services
H0025HK
One day, at least 3 hours in duration
$166.12
Intensive Day Treatment
H2012HK
One day, at least 5 hours in duration
$222.22
Community-Based Intervention (Level I – Multi-Systemic Therapy)
H2033HK
15 minutes
$77.52
Community-Based Intervention (Level II and Level III)
H2022HK
15 minutes
$48.25
Community-Based Intervention (Level IV – Functional Family Therapy)
H2033HUHK
15 minutes
$77.52
Assertive Community
Treatment
H0039HK
15 minutes
$51.35 – Individual
H0039HQHK
15 minutes
$15.54 – Group
Trauma Focused Cognitive Behavioral Therapy
H004STHK
15 minutes
$48.25
Child-Parent Psychotherapy for Family Violence
H004HTHK
15 minutes
$48.25
5213.3The Department of Behavioral Health (DBH) shall be responsible for payment of the District's share or the local match for all MHRS in accordance with the terms and conditions set forth in the Memorandum of Understanding between Department of Health Care Finance (DHCF) and DBH. DHCF shall claim the federal share of financial participation for all MHRS services.
5213.4Providers shall not bill the client or any member of the client's family for MHRS services. DBH shall bill all known third-party payors prior to billing the Medicaid Program.
5213.5Medicaid reimbursement for MHRS is not available for:
(a)Room and board costs;
(b)Inpatient services (including hospital, nursing facility services, intermediate care facility for persons with mental retardation services, and Institutions for Mental Diseases services);
(c)Transportation services;
(d)Vocational services;
(e)School and educational services;
(f)Services rendered by parents or other family members;
(g)Socialization services;
(h)Screening and prevention services (other than those provided under Early and Periodic, Screening Diagnostic Treatment requirements);
(i)Services which are not medically necessary, or included in an approved Individualized Recovery Plan for adults or an Individualized Plan of Care for children and youth;
(j)Services which are not provided and documented in accordance with DBH-established MHRS service-specific standards; and
(k)Services furnished to a person other than the Medicaid client, when those services are not used exclusively for the well-being and benefit of the Medicaid client.