Section 29-949. REIMBURSEMENT PRINCIPLES AND LIMITATIONS GOVERNING PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES

 

949.1Each PRTF shall be reimbursed on a prospective basis at a facility-specific per

diem rate.  

 

949.2Each PRTF located in the District of Columbia shall be reimbursed at a rate equal to the average rate paid by the State of Maryland Medicaid Program as of July 1 each year for comparable services and provider type. The reimbursement rate calculated pursuant to this section shall become effective  October 1 of  each year  in which the average rate was determined and shall remain in effect for a full year.   

 

949.3Each PRTF located outside of the District of Columbia may be reimbursed for services provided to District Medicaid beneficiaries who are residents of the District of Columbia. The reimbursement rates shall be determined as set forth in §§ 949.4 through 949.6.

 

949.4If the PRTF located outside of the District of Columbia is enrolled in the Medicaid Program in the state in which the facility is located, the reimbursement rate shall be the same rate paid by the state in which the facility is located as of July 1 of each year, for comparable services rendered by a comparable provider type. The reimbursement rate shall be effective October 1 of each year and shall remain in effect for a full year. Each PRTF shall enroll in the District’s Medicaid Program and provide documentation of its enrollment in the Medicaid Program in the state in which the facility is located.

 

949.5If the PRTF located outside of the District of Columbia is not enrolled in the Medicaid Program in the state in which the facility is located, the reimbursement rate shall be the established payment rate for services charged to other third party payers. Each PRTF shall enroll in the District’s Medicaid Program and be certified by the Department of Mental Health before accepting District Medicaid beneficiaries for services.

 

949.6If the PRTF located outside of the District of Columbia is not enrolled in the Medicaid Program in the state in which the facility is located does not charge other third party payers, the reimbursement rate shall be the lowest rate charged to a self-paying recipient of services.  Each PRTF shall enroll in the District’s Medicaid Program and be certified by the Department of Mental Health before accepting District Medicaid beneficiaries for services.

 

949.7All provider appeals shall be governed in accordance with the requirements set forth in Chapter 13 of Title 29 of the District of Columbia Municipal Regulations. 

 

 

949.99DEFINITIONS 

 

For the purposes of sections 948 and 949, the following terms shall have the meanings ascribed:

 

Psychiatric residential treatment facility- a psychiatric facility that is not a hospital and is accredited by the Joint Commission on Accreditation of Healthcare Organizations, the Commission on Accreditation of Rehabilitation Facilities, the Council on Accreditation of Services for Families and Children, or by any other accrediting organization with comparable standards that is recognized  by the state in which it is located and provides inpatient psychiatric services for individuals under the age of twenty-two (22) and meets the requirements set forth in §§ 441.151 through 441.182 of Title 42 of the Code of Federal Regulations.

 

Psychiatrist -a person who is licensed to practice psychiatry pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 26, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1202 et seq.) and implementing regulations or licensed as a psychiatrist in the jurisdiction where the services are being provided.

 

Psychologist - a person who is licensed to practice psychology pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1202 et seq.) and implementing regulations or licensed as a psychologist in the jurisdiction where the services are being provided.

 

Registered nurse - a person who is licensed as a registered nurse pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1202 et seq.) and implementing regulations or licensed as a registered nurse in the jurisdiction where the services are being provided.

 

Occupational therapist - a person who is licensed or authorized to practice occupational therapy pursuant to the District of Columbia Health Occupations Revision Act of 1985, effective March 25, 1986 (D.C. Law 6-99; D.C. Official Code § 3-1201 et seq.) and implementing regulations or licensed as an occupational therapist in the jurisdiction where the services are provided.

 

 

 

 

authority

Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code §1-307.02) and the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109;D.C. Official Code § 7-771.05(6))

source

Final Rulemaking published at 37 DCR 6812, 6815 (October 26, 1990); as amended by Final Rulemaking published at 44 DCR 5492 (September 26, 1997); as amended by Final Rulemaking published at 57 DCR 1709, 1712 (February 26, 2010) and corrected at 57 DCR 1892, 1895 (March 5, 2010).