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DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF FINAL 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), 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 of amendments to section 5213, “Reimbursement,” of Chapter 52, “Medicaid Reimbursement For Mental Health Rehabilitative Services,” of Title 29, “Public Welfare,” of the District of Columbia Municipal Regulations (DCMR).
These rules will establish a new billing code for Assertive Community Treatment (ACT) Groups. Issuance of these rules is necessary in order for ACT providers to offer group services to Department of Mental Health consumers in the ACT program. Group treatment is often helpful for mental health treatment. The use of group treatment is also a factor in assessing the quality of ACT services offered by a provider. Without a group rate, ACT providers rarely offer group services because they cannot bill individually for consumers who are participating in group activities, and therefore a valuable treatment tool is unavailable for consumers. Establishment of this billing code and rate for ACT groups will resolve the problem.
A notice of proposed rulemaking was published in the D.C. Register on September 24, 2010 at 57 DCR 8774. No comments on the proposed rules were received. No substantive changes have been made. These rules shall become effective on the date of publication of this notice in the D.C. Register.
Section 5213, “Reimbursement,” of 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 amended to read as follows:
5213 REIMBURSEMENT
5213.1 Medicaid reimbursement for MHRS shall be determined as follows:
SERVICE
CODE
BILLABLE UNIT OF SERVICE
RATE
Diagnostic/Assessment
T1023HE
An assessment, at least 3 hours in duration
$240.00
H0002
An assessment, 40 – 50 minutes in duration, to determine eligibility for admission to a mental health treatment program
$85.00
Medication/Somatic
Treatment
T1502
15 minutes
$35.72 –Individual
(ages 22 and over)
T1502HA
15 minutes
$38.96 – Individual
(ages 0 – 21)
T1502HQ
15 minutes
$19.33 – Group
Counseling
H0004
15 minutes
$19.50 – Individual, on-site
(ages 22 and over)
H004HA
15 minutes
$20.31 – Individual, on-Site
(ages 0 – 21)
H004HQ
15 minutes
$10.45 – Group
Community Support
H0036
15 minutes
$20.10 – Individual
H0036HQ
15 minutes
$8.67 – Group
Crisis/Emergency
H2011
15 minutes
$33.57
Day Services
H0025
One day, at least 3 hours
$144.77
in duration
Intensive Day Treatment
H2021
One day, at least 5 hours
$164.61
in duration
Community-Based Intervention (Level I- Multi-systemic Therapy)
H2033
15 minutes
$57.42
Community-Based Intervention (Level II and Level III)
H2022
15 minutes
$31.35
Assertive Community
Treatment
H0039
15 minutes
$33.23 – Individual
H0039HQ
15 minutes
$11.07 – Group
