Section 29-988. MEDICAID FEE SCHEDULE

 

988.1 The Medicaid fee schedule includes reimbursement rates for Medicaid covered services and is posted at www.dc-medicaid.com.

 

988.2 Medicaid covered services that are listed  on the fee schedule include, but are not limited to, the following services:

 

(a) Laboratory and x-ray services;

 

(b) Physicians’ services;

 

(c) Medical care and other types of remedial care;

 

(d) Home health services;

 

(e) Dental services;

 

(f)Durable Medicaid Equipment (DME);

 

(f) Diagnostic, screening, preventive, and rehabilitative services; and

 

(g) Hospice care.

 

988.3 DHCF shall review the Medicaid fee schedule periodically. The Medicaid fee schedule may be adjusted where necessary to:

 

(a) Comply with changes in federal or District requirements;

 

(b) Comply with changes in nationally-recognized coding systems, such as Healthcare Common Procedure Coding System (HCPCS), Current Procedural Terminology (CPT), and Code on Dental Procedures and Nomenclature (CDT);

 

(c) Establish an initial allowable amount for a new procedure or a procedure based on information that was not available when the fee schedule was established for the current calendar year; and

 

(d) Adjust the allowable amount when DHCF determines that the current allowable amount is:

 

(1) Not appropriate for the service provided;

 

(2) Based on errors in data or calculation; or

 

(3) Ineffective for proper or efficient administration of the State Medicaid Program

 

988.4 DHCF shall publish a Public Notice in the D.C. Register which informs the public of changes to the Medicaid fee schedule. The Public Notice shall be published at least thirty (30) calendar days in advance of the change. The Notice shall describe the type of change, the reason for the change, the effective date of the change, and the Medicaid reimbursement rate.  If the Public Notice of the changes to the Medicaid fee schedule exceeds two (2) pages, DHCF shall post the changes in the fee schedule consistent with the requirements set forth in this section on a website maintained by DHCF and include the website address  in the Public Notice. 

 

988.5 In those instances where a Medicaid fee is included in a rule, DHCF shall amend and publish the revised rule in the D.C. Register pursuant to the procedures of title I of the District of Columbia Administrative Procedure Act, effective March 25, 1977 (D.C. Law 1-96; D.C. Official Code §§ 2-501 et seq.), and the requirement of § 988.4 shall not apply.

 

authority

An Act to enable the District of Columbia (District) 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 (2014 Repl. & 2015 Supp.)), and Section 6(6) of 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) (2012 Repl.)).

source

Final Rulemaking published at 63 DCR 40 (January 1, 2016).