-
DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF EMERGENCY AND PROPOSED RULEMAKING
The Interim Director of the Department of Health Care Finance, pursuant to the authority set forth in An 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. 744; D.C. Official Code § 1-307.02), 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)), hereby gives notice of the adoption, on an emergency basis, of an amendment to section 5213 of Chapter 52, “Medicaid Reimbursement for Mental Health Rehabilitative Services,” of Title 29, “Public Welfare,” of the District of Columbia Municipal Regulations (DCMR).
The purpose of these proposed and emergency rules is to (1) set forth the new billing rates for Assertive Community Treatment (ACT) and Community Support – Individual to reflect rate reductions for fiscal year 2011 and (2) to set forth the new billing rates for ACT and Community Support – Individual to reflect the revised rates for fiscal year 2012. The 2011 rates will become effective February 1, 2011, covering only eight (8) months of billing at the new rate for fiscal year 2011; therefore, a higher rate cut from the 2010 rates will occur for fiscal year 2011 than will occur for fiscal year 2012, since the fiscal year 2012 rates cover twelve (12) months of billing at the new rate. Thus, the fiscal year 2011 rates reflect a seven-point-five percent (7.5%) reduction from the 2010 rates, while the fiscal year 2012 rates reflect a five percent (5%) rate cut from the 2010 rates.
Issuance of these rules on an emergency basis is necessary to ensure the continued provision of necessary mental health services while faced with a budget deficit that requires an immediate decrease in expenditures. Any delay in promulgating the new rates would require a further decrease in the reimbursement rates in order to decrease the government expenditures in the equivalent amount, which would increase the burden on the mental health providers and lead to a detrimental decrease in services. Thus emergency action is necessary for the immediate preservation of the health, welfare, and safety of children, youth, and adults with mental illness in need of mental health services.
The emergency rulemaking was adopted on January 21, 2011, and will become effective for services rendered on or after February 1, 2011. The emergency rules will remain in effect for one hundred twenty (120) days or until May 20, 2011, unless superseded by publication of another rulemaking notice in the D.C. Register.
The Interim 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.
Chapter 52, MEDICAID REIMBURSEMENT FOR MENTAL HEALTH REHABILITATIVE SERVICES, of Title 29, PUBLIC WELFARE, of the DCMR is amended as follows:
Subsection 5213.1 is deleted in its entirety and is amended to read as follows:
5213.1 Medicaid reimbursement for MHRS shall be determined as follows:
SERVICE
CODE
BILLABLE UNIT
OF SERVICE
RATE
EFFECTIVE
FEB. 1, 2011
RATE
EFFECTIVE
OCT. 1, 2012
Diagnostic/
Assessment
T1023HE
An assessment,
at least 3
$240.00
$240.00
hours in duration
H0002
An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program
$85.00
$85.00
Medication/
Somatic Treatment
T1502
15 minutes
$35.72 –
Individual
(ages 22 and over)
$35.72 –
Individual
(ages 22 and over)
T1502HA
15 minutes
$38.96 –
Individual
(ages 0 – 21)
$38.96 –
Individual
(ages 0 – 21)
T1502HQ
15 minutes
$19.33 – Group
$19.33 –
Group
Counseling
H0004
15 minutes
$19.50
Individual
On-site
(ages 22 and
over)
$19.50
Individual
On-Site
(ages 22 and over)
H004HA
15 minutes
$20.31 –
Individual
On-Site
(ages 0 – 21)
$20.31 –
Individual
On-Site
(ages 0 – 21)
H004HQ
15 minutes
$10.45 – Group
$10.45 –
Group
Community Support
H0036
15 minutes
$18.59
Individual
$19.19
Individual
H0036HQ
15 minutes
$8.67 Group
$8.67 Group
Crisis/
Emergency
H2011
15 minutes
$33.57
$33.57
Day Services
H0025
One day, at least 3 hours in duration
$144.77
$144.77
Intensive Day Treatment
H2021
One day, at least 5 hours in duration
$164.61
$164.61
Community-Based Intervention (Level I)
H2033
15 minutes
$57.42
$57.42
Community-Based Intervention (Level II and Level III)
H2022
15 minutes
$31.35
$31.35
Assertive Community
H0039
15 minutes
$30.74
Individual
$31.57
Individual
Treatment
H0039HQ
15 minutes
$11.07 Group
$11.07 Group
Comments on this proposed rulemaking shall be submitted in writing to Linda Elam, Interim Director, Department of Health Care Finance, 899 North Capitol Street, NE, 6th Floor, Washington, DC 20002, within thirty (30) days after the date of publication of this notice in the D.C. Register. Additional copies of this proposed rule may be obtained from the above address.
