5762981 Health Care Finance, Department of - Notice of Emergency and Proposed Rulemaking - Governing Reimbursement for Mental Health Rehabiliative Services

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 (2014 Repl.)) 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.)), 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 amendment is to establish reimbursement rates and codes for two new MHRS services recently authorized through a Medicaid State Plan Amendment (SPA). They are Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Child-Parent Psychotherapy – Family Violence (CPP-FV).  TF-CBT is designed primarily to help young children ages four to eighteen (4-18) who have suffered traumatic life events; CPP-FV is a relationship-based treatment designed for children ages zero to six (0-6) who have suffered trauma and as a result have difficulty regulating their behaviors and emotions.

 

Additionally, a new program to train family members as peers to assist other families who have children with serious mental disorders has been developed. This assistance is a type of Community Support and the new code and rate reflect that particular service. The new rate has been added to reflect the new Certified Peer Specialist – Family Service.  Department of Behavioral Health (DBH) has a Certified Peer Program for peers who are often critical to the engagement and success of people, including families with children, who have mental illness or serious emotional disorders.  

 

Issuance of these rules, on an emergency basis, is necessary to ensure the continued provision of these critical mental health services to very young District residents with mental illness who are in need of services to develop in a healthy manner inside the family unit. Further, these services will support family members in need of assistance from other experienced family peers who are able to fully assist their children.  These services were not fully reimbursable prior to the SPA. Providers need to be appropriately reimbursed in order to serve those very young children who need these critical services to overcome trauma in their lives and achieve recovery. Thus, emergency action is necessary for the immediate preservation of the health, welfare, and safety of children, youth, and their families in need of mental health services.

 

This emergency and proposed rulemaking was adopted on November 25, 2015, and became effective on that date. These rules shall remain in effect for one hundred and twenty (120) days, expiring March 24, 2016, unless superseded by publication of a Notice of Final Rulemaking in the D.C. Register.  The 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 DCMR, PUBLIC WELFARE, is amended as follows:

 

Section 5213, REIMBURSEMENT, is amended to read as follows:

 

5213                                REIMBURSEMENT

 

5213.1                          Medicaid reimbursement for Mental Health Rehabilitative Services (MHRS) provided to consumers other than consumers who are deaf or hearing-impaired shall be determined as follows:

 

SERVICE	CODE	BILLABLE UNIT OF SERVICE	RATE
Diagnostic/ Assessment	T1023HE	An assessment, at least 3 hours in duration	$256.02
	H0002	An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program	$85.34
Medication Training& Support	H0034	15 minutes	$44.65 – Individual
	H0034HQ	15 minutes	$13.52 – Group
Counseling	H0004	15 minutes	$26.42 – Individual
	H0004HQ	15 minutes	$8.00 – Group
	H0004HR	15 minutes	$26.42 – Family with Consumer  On-Site
	H0004HS	15 minutes	$26.42 – Family without Consumer On-Site
	H0004HETN	15 minutes	$27.45   – Individual Off-Site
Community Support	H0036	15 minutes	$21.97 – Individual
	H0036HQ	15 minutes	$6.65 – Group
	H0036UK	15 minutes	$21.97 – Collateral
	H0036AM	15 minutes	$21.97 – Physician Team Member
	H0038   H0038HQ     H0038HS     H0038HQHS     H0036HR   H0036HS   H0036U1	15 minutes   15 minutes     15 minutes     15 minutes     15 minutes   15 minutes   15 minutes	$21.97 – Self-Help Peer Support   $6.65  –Self-Help Peer Support Group   $21.97 – Family/Couple Peer Support without Consumer   $6.65 – Family/Couple Peer  Support Group Without Consumer   $21.97 – Family with Consumer   $21.97 – Family without Consumer   $21.97– Community Residence Facility
	H2023	15 minutes	$18.61– Supported Employment (Therapeutic)
Crisis/ Emergency	H2011	15 minutes	$36.93
Day Services	H0025	One day, at least 3 hours in duration	$123.05
Intensive Day Treatment	H2012	One day, at least 5 hours in duration	$164.61
Community-Based Intervention (Level I – Multi-Systemic Therapy)	H2033	15  minutes	$57.42
Community-Based Intervention (Level II and Level III)	H2022	15 minutes	$35.74
Community-Based Intervention (Level IV – Functional Family Therapy)	H2033HU	15 minutes	$57.42
Assertive Community Treatment	H0039	15 minutes	$38.04 – Individual
	H0039HQ	15 minutes	$11.51 – Group
Trauma Focused Cognitive Behavioral Therapy	H004ST	15 minutes	$35.74
Child-Parent Psychotherapy for Family Violence	H004HT	15 minutes	$35.74

 

 

5213.2                          Medicaid reimbursement for MHRS provided to consumers who are deaf or hearing-impaired shall be determined as follows:

 

SERVICE	CODE	BILLABLE UNIT OF SERVICE	RATE
Diagnostic/ Assessment	T1023HEHK	An assessment, at least 3 hours in duration	$345.63
	H0002HK	An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program	$115.21
Medication Training& Support	H0034HK	15 minutes	$60.28 – Individual
	H0034HQHK	15 minutes	$18.25 – Group
Counseling	H0004HK	15 minutes	$35.67 – Individual
	H0004HQHK	15 minutes	$10.80 – Group
	H0004HRHK	15 minutes	$35.67 – Family with Consumer  On-Site
	H0004HSHK	15 minutes	$35.67 – Family without Consumer On-Site
Community Support	H0036HK	15 minutes	$29.66 – Individual
	H0036HQHK	15 minutes	$8.98 – Group
	H0036UKHK	15 minutes	$29.66 – Collateral
	H0036AMHK	15 minutes	$29.66 – Physician Team Member
	H0038HK   H0038HQHK     H0038HSHK     H0038HQHK     H0036HRHK   H0036HSHK   H0036U1HK	15 minutes   15 minutes     15 minutes     15 minutes     15 minutes   15 minutes   15 minutes	$29.66 – Self-Help Peer Support   $8.98  –Self-Help Peer Support Group   $29.66 – Family/Couple Peer Support without Consumer   $8.98 – Family/Couple Peer Support Group Without Consumer   $29.66 – Family with Consumer   $29.66 – Family without Consumer   $29.66– Community Residence Facility
	H2023HK	15 minutes	$25.12 Supported Employment (Therapeutic)
Crisis/ Emergency	H2011HK	15 minutes	$49.85
Day Services	H0025HK	One day, at least 3 hours in duration	$166.12
Intensive Day Treatment	H2012HK	One day, at least 5 hours in duration	$222.22
Community-Based Intervention (Level I – Multi-Systemic Therapy)	H2033HK	15  minutes	$77.52
Community-Based Intervention (Level II and Level III)	H2022HK	15 minutes	$48.25
Community-Based Intervention (Level IV – Functional Family Therapy)	H2033HUHK	15 minutes	$77.52
Assertive Community Treatment	H0039HK	15 minutes	$51.35 – Individual
	H0039HQHK	15 minutes	$15.54 – Group
Trauma Focused Cognitive Behavioral Therapy	H004STHK	15 minutes	$48.25
Child-Parent Psychotherapy for Family Violence	H004HTHK	15 minutes	$48.25

 

5213.3             DBH shall be responsible for payment of the District's share or the local match for all MHRS in accordance with the terms and conditions set forth in the Memorandum of Understanding between Department of Health Care Finance (DHCF) and Department of Behavioral Health (DBH). DHCF shall claim the federal share of financial participation for all MHRS services.

            

5213.4             Providers shall not bill the client or any member of the client's family for MHRS services. DBH shall bill all known third-party payors prior to billing the Medicaid Program.

 

5213.5             Medicaid reimbursement for MHRS is not available for:

 

(a)        Room and board costs;

 

(b)        Inpatient services (including hospital, nursing facility services, intermediate care facility for persons with mental retardation services, and Institutions for Mental Diseases services);

 

(c)        Transportation services;

 

(d)       Vocational services;

 

(e)        School and educational services;

 

(f)        Services rendered by parents or other family members;

 

(g)        Socialization services;

 

(h)        Screening and prevention services (other than those provided under Early and Periodic, Screening Diagnostic Treatment requirements);

 

(i)         Services which are not medically necessary, or included in an approved Individualized Recovery Plan for adults or an Individualized Plan of Care for children and youth;

 

(j)         Services which are not provided and documented in accordance with DBH-established MHRS service-specific standards; and

 

(k)        Services furnished to a person other than the Medicaid client when those services are not directed exclusively to the well-being and benefit of the Medicaid client.

 

 

Comments on this proposed rulemaking shall be submitted in writing to Claudia Schlossberg, Senior Deputy/Medicaid Director, Department of Health Care Finance, 441 4^th Street, N.W., 9^th Floor South, Washington, D.C.  20001, via email to [e-mail], online at www.dcregs.dc.gov, or by telephone to [phone], 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.