5794700 Behavioral Health, Department of - Notice of Emergency and Proposed Rulemaking - Reimbursement Rates for services provided by DBH Chapter 63 Substance Use Treatment and Recovery Providers with a Human Care Agreement
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DEPARTMENT OF BEHAVIORAL HEALTH
NOTICE OF EMERGENCY AND PROPOSED RULEMAKING
The Acting Director of the Department of Behavioral Health (“the Department”), pursuant to the authority set forth in Sections 5113, 5115, 5117 and 5118 of the Department of Behavioral Health Establishment Act of 2013, effective December 24, 2013 (D.C. Law 20-61; D.C. Official Code §§ 7-1141.02, 7-1141-04, 7-1141.06 and 7-1141.07 (2012 Repl.)), hereby gives notice of the intent to adopt a new Chapter 64, “Reimbursement Rates for Services Provided by the Department of Behavioral Health Chapter 63 Certified Substance Use Disorder Providers” to Subtitle A (Mental Health) of Title 22 (Health) of the District of Columbia Municipal Regulations (DCMR).
The purpose of these proposed and emergency rules is to set forth the reimbursement rates for services provided to eligible District residents, twenty-one (21) years of age or older, by substance use disorder treatment and recovery providers who have been certified pursuant to Chapter 63 of this title and have an active Human Care Agreement with the Department to provide such services.
Issuance of these rules on an emergency basis is necessary to ensure the continued provision of essential substance use disorder treatment services as providers are certified under a new chapter with new service standards. The Department of Behavioral Health created new certification standards promulgated in Chapter 63 of this title to 1) generally update the substance use disorder treatment and recovery service requirements to reflect improvements in the American Society of Addiction Medicine (“ASAM”) practice guidelines; 2) align the certification requirements with other certified programs within the authority of the Department of Behavioral Health; and 3) include the requirements of the Adult Substance Abuse Rehabilitation Services (“ASARS”) State Plan Amendment (“SPA”) which enables Medicaid reimbursement for services falling within the ASARS requirements. This reimbursement rule is necessary in order to reimburse providers using non-Medicaid local District funds for non-Medicaid services provided under that chapter. Delay in promulgating the published reimbursement rates would result in interruption of substance use disorder services. Therefore, emergency action is necessary for the immediate preservation of the critical substance use disorder treatment and recovery services that will ensure the health, welfare, and safety of individuals with substance abuse disorders.
The emergency rulemaking was adopted on November 19, 2015 and is effective for services rendered on or after December 1, 2015 by a provider certified pursuant to Chapter 63 of this title. The emergency rules will remain in effect for one hundred twenty (120) days after adoption or until March 18, 2016, unless superseded by publication of another rulemaking notice in the D.C. Register.
The Acting Director also gives notice of intent to take final rulemaking action to adopt the proposed rules in not less than thirty (30) days after the date of publication of this notice in the D.C. Register.
Title 22-A DCMR, MENTAL HEALTH, is amended by adding a new Chapter 64 to read as follows:
CHAPTER 64 REIMBURSEMENT RATES FOR SERVICES PROVIDED BY THE DEPARTMENT OF BEHAVIORAL HEALTH CHAPTER 63 CERTIFIED SUBSTANCE USE DISORDER PROVIDERS
6400 PURPOSE
6400.1 This chapter establishes the reimbursement rate for services provided to eligible District residents ages twenty-one (21) and older by Department of Behavioral Health (Department) certified substance use disorder providers, as this term is defined in Chapter 63 (Certification Standards for Substance Use Disorder Treatment and Recovery Providers) of Subtitle A (Mental Health) of Title 22 (Health) of the District of Columbia Municipal Regulations (DCMR).
6400.2 Establishment of these reimbursement rates will allow the Department to reimburse providers using non-Medicaid local funds for services provided in accordance with the Human Care Agreement to those clients who are not eligible for Medicaid funding and for those services that are not reimbursable by Medicaid. Reimbursement rates using non-Medicaid local funds are equivalent to the reimbursement rates for equivalent services which may be reimbursable by Medicaid.
6400.3 Nothing in this chapter grants to a certified substance use disorder provider the right to reimbursement for costs of substance use disorder services and supports. Eligibility for reimbursement is determined solely by the Human Care Agreement between the Department and the certified substance use disorder provider, and reimbursement is subject to the availability of appropriated funds.
6401 REIMBURSEMENT RATE
6401.1 Reimbursement for substance abuse services shall be as follows:
SERVICE
CODE
RATE per
UNIT
UNIT
Urinalysis (Laboratory)
H0003
15.00
Per service
Breathalyzer Collection
H0048
8.80
Per service
Urinalysis Collection
H0048LR
8.80
Per service
Case Management
H0006
21.97
15 min.
Case Management (HIV)
H0006HKHF
21.97
15 min.
Clinical Care Coordination
T1017HF
26.42
15 min.
Counseling, Group
H0005
8.00
15 min.
Counseling, Group, Psycho-educational
H2027HQ
6.65
15 min.
Counseling, Group , Psycho-educational (HIV)
H2027HQHF
6.65
15 min.
Counseling, Individual, On-site, Behavioral Health Therapy
H0004HF
26.42
15 min.
Counseling, Individual, Off-site
H0004HFTN
27.45
15 min.
Counseling, Family with Client
H0004HFHR
26.42
15 min.
Counseling, Family without Client
H0004HFHS
26.42
15 min.
Crisis Intervention
H0007HF
36.93
15 min.
Short-term MMIWM
H0010
605.00
Per diem
Behavioral Health Screening, Initial, Determine eligibility
H0002HF
85.34
Per service
Behavioral Health Assessment, on-going, Risk Rating
H0002TG
140.00
Per service
Diagnostic Assessment, Comprehensive, Adult
H0001
256.02
Per service
Diagnostic Assessment, Brief, Modify Tx Plan
H0001TS
85.34
Per service
Medication Assisted Treatment, Methadone, Clinic or Take Home
H0020
8.58
Dose
Medication Assisted Therapy, Administration
H0020HF
8.58
Per
Service
Medication Management, Adult
H0016
44.65
15 min.
Multi-systemic Therapy for Transition Age Youth (TAY) (ACRA) (ages 21 – 24)
H2033HF
57.42
15 min.
Residential Treatment, Room & Board
H0043
72.90
Per diem
Residential Treatment, Room & Board, Woman w/1 child
H0043UN
210.00
Per diem
Residential Treatment, Room & Board, Woman w/2 children
H0043UP
215.00
Per diem
Residential Treatment, Room & Board, Woman w/3 children
H0043UQ
220.00
Per diem
Residential Treatment, Room & Board, Women w/4 or more children
H0043UR
225.00
Per diem
Recovery Support Evaluation, Alcohol/drug Assessment
H0001HF
85.34
Per service
Case Management, Recovery Support
T1017
21.97
15 min.
Environmental Stability, Supported Housing, Individual
H0044HF
849.00
Per month
Environmental Stability, Supported Housing, Woman w/children
H0044HFUN
1000.00
Per month
Prevention Education Service, Recovery Mentoring, Coaching
H0025HF
21.97
15 min.
Training and Skills Development, Life Skills, Individual
H2014
21.97
15 min.
Training and Skills Development, Life Skills, Adult, Group
H2014HQ
6.65
15 min.
Substance Use Disorder Services NOS, Spiritual Support Group
H0047HF
6.65
15 min.
PsychoSocial Rehabilitative Service, Recovery Social Activities, Group
H2017HQ
6.65
15 min.
PsychoSocial Rehabilitative Service, Education Services, Individual
H2017HF
21.97
15 min.
PsychoSocial Rehabilitative Service, Education Services, Group
H2017HFHQ
6.65
15 min.
6402 REIMBURSEMENT RATE FOR CLIENTS WHO ARE DEAF OR HARD-OF-HEARING
6402.1 Reimbursement for substance abuse services provided to clients who are deaf or hard-of-hearing by a provider certified to provide services to clients who are deaf or hard-of-hearing shall be as follows:
SERVICE
CODE
RATE per
UNIT
UNIT
Urinalysis (Laboratory)
H0003HK
15.00
Per service
Breathalyzer Collection
H0048HK
11.88
Per service
Urinalysis Collection
H0048LRHK
11.88
Per service
Case Management
H0006HK
29.66
15 min.
Case Management (HIV)
H0006HKHFHV
29.66
15 min.
Clinical Care Coordination
T1017HFHK
35.67
15 min.
Counseling, Group
H0005HK
10.80
15 min.
Counseling, Group, Psycho-educational
H2027HQHK
8.97
15 min.
Counseling, Group , Psycho-educational (HIV)
H2027HQHFHK
8.97
15 min.
Counseling, Individual, On-site, Behavioral Health Therapy
H0004HFHK
35.68
15 min.
Counseling, Individual, Off-site
H0004HFTNHK
37.06
15 min.
Counseling, Family with Client
H0004HFHRHK
35.68
15 min.
Counseling, Family without Client
H0004HFHSHK
35.68
15 min.
Crisis Intervention
H0007HFHK
49.85
15 min.
Short-term MMIWM
H0010HK
816.75
Per diem
Behavioral Health Screening, Initial, Determine eligibility
H0002HFHK
115.21
Per service
Behavioral Health Assessment, on-going, Risk Rating
H0002TGHK
189.00
Per service
Diagnostic Assessment, Comprehensive, Adult
H0001HK
345.63
Per service
Diagnostic Assessment, Brief, Modify Treatment Plan
H0001TSHK
115.21
Per Service
Medication Assisted Treatment, Methadone, Clinic or Take Home
H0020HK
8.58
Dose
Medication Assisted Therapy, Administration
H0020HFHK
11.58
Service
Medication Management, Adult
H0016HK
60.28
15 min.
Multi-systemic Therapy for Transition Age Youth (TAY) (ACRA) (ages 21 – 24)
H2033HFHK
77.52
15 min.
Residential Treatment, Room & Board
H0043HK
98.42
Per diem
Residential Treatment, Room & Board, Woman w/1 child
H0043UNHK
283.50
Per diem
Residential Treatment, Room & Board, Woman w/2 children
H0043UPHK
290.25
Per diem
Residential Treatment, Room & Board, Woman w/3 children
H0043UQHK
297.00
Per diem
Residential Treatment, Room & Board - Women w/4 or more children
H0043URHK
303.75
Per diem
Recovery Support Evaluation, Alcohol/drug Assessment
H0001HK
115.21
Per service
Case Management, Recovery Support
T1017HFHK
29.66
15 min.
Environmental Stability, Supported Housing, Individual
H0044HFHK
849.00
Per month
Environmental Stability, Supported Housing, Woman w/children
H0044HFUNHK
1000.00
Per month
Prevention Education Service, Recovery Mentoring, Coaching
H0025HFHK
29.66
15 min.
Training and Skills Development, Life Skills, Individual
H2014HK
29.66
15 min.
Training and Skills Development, Life Skills, Adult, Group
H2014HQHK
8.98
15 min.
Substance Use Disorder Services NOS, Spiritual Support Group
H0047HFHK
8.98
15 min.
PsychoSocial Rehabilitative Service, Recovery Social Activities, Group
H2017HQHK
8.98
15 min.
PsychoSocial Rehabilitative Service, Education Services, Individual
H2017HFHK
29.66
15 min.
PsychoSocial Rehabilitative Service, Education Services, Group
H2017HFHQHK
8.98
15 min.
All persons desiring to comment on the subject matter of this proposed rulemaking should file comments in writing not later than thirty (30) days after the date of publication of this notice in the D.C. Register. Comments should be filed with the Suzanne Fenzel, Deputy Director, Office of Strategic Planning, Policy and Evaluation, Department of Behavioral Health, at 64 New York Ave., NE, 3nd Floor, Washington, D.C. 20002, or e-mailed to Suzanne.Fenzel@dc.gov. Copies of the proposed rules may be obtained from dbh.dc.gov or from the Department of Behavioral Health at the address above.
