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DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF EMERGENCY AND PROPOSED RULEMAKING
The 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 (2006 Repl. & 2011 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)( 2008 Repl.), 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 this emergency and proposed rule is to set forth the billing rate for the Mental Health Rehabilitation Service - Community-Based Intervention – Level IV, known as Functional Family Therapy (FFT). FFT is an intensive mental health service designed for children, youth and their families to prevent children already involved in the juvenile justice system from further penetrating the legal system. Previously, FFT was funded through local District funding; however, beginning October 1, 2011, FFT may be funded as a Medicaid-reimbursable service. Thus, this rule reflects the appropriate code and reimbursement rate for that service. The new reimbursement rate is no different than the rate that was paid using local District funds.
Issuance of this rule on an emergency basis is necessary to ensure the continued provision of these critical mental health services while faced with a budget deficit that requires an immediate decrease in expenditures. Without the assistance of Medicaid reimbursement, these services could not be continued at the needed level for these children, youth and their families with the most intense needs. Thus emergency action is necessary for the immediate preservation of the health, welfare, and safety of children, youth, and their families with mental illness in need of mental health services.
This emergency and proposed rulemaking was adopted on October 1, 2011, and became effective on that date. The emergency rules will remain in effect for one hundred twenty (120) days or until January 28, 2012, unless superseded by publication of another rulemaking notice in the D.C. Register, whichever comes first.
The Director also gives notice of intent to take final rulemaking action to adopt the proposed rule 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:
Section 5213, Reimbursement, 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, 2011
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 – Multi-Systemic Therapy)
H2033
15 minutes
$57.42
$57.42
Community-Based Intervention (Level II and Level III)
H2022
15 minutes
$31.35
$31.35
Community-Based Intervention (Level IV – Functional Family Therapy)
H2033HU
15 minutes
$57.42
$57.42
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 Wayne Turnage, Director, Department of Health Care Finance, 899 North Capitol Street, NE, 6th Floor, Washington, DC 20002, within thirty (30) days of 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.
