4749331 Behavioral Health, Department of - Notice of Second Emergency and Proposed Rulemaking - Reimbursement Rates for Services Provided by the Department of Behavioral Health-Certified Substance Abuse Providers

DEPARTMENT OF BEHAVIORAL HEALTH

 

NOTICE OF SECOND EMERGENCY AND PROPOSED RULEMAKING

 

The Director of the Department of Behavioral Health (Department), pursuant to the authority set forth in Sections 5113, 5115, 5117, and 5118 of the “Fiscal Year 2014 Budget Support Congressional Review Emergency Act of 2013”, signed November 8, 2013 (D.C. Act 20-0204, 60 DCR 15341 (November 8, 2013), and any similar succeeding legislation, hereby gives notice of the adoption, on an emergency basis, of a new Chapter 62, “Reimbursement Rates for Services Provided by the Department of Behavioral Health-Certified Substance Abuse 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 by Department-certified substance abuse treatment facilities and programs which have an active Human Care Agreement with the Department to provide such services.  This Notice of Second Emergency and Proposed Rulemaking makes one change to the original Notice of Emergency and Proposed Rulemaking adopted on October 1, 2013, and published in the D.C. Register on October 18, 2013 at 60 DCR 014839, by including the reimbursement rate for two (2) Family Counseling services.

 

Issuance of these rules on an emergency basis is necessary to ensure the continued provision of essential substance abuse treatment services under a uniform rate structure.  The Department was created effective October 1, 2013 by a merger between the Department of Mental Health and the Addiction, Prevention and Recovery Administration of the Department of Health in order to allow for better integrated services for individuals with mental health and substance abuse issues.  The merger required changes in provider Human Care Agreements and the development of uniform rates to avoid disparate rates across the provider network.  Delay in promulgating the published reimbursement rates would result in interruption of substance abuse services.   Therefore, emergency action is necessary for the immediate preservation of the critical substance abuse treatment services that will ensure the health, welfare, and safety of individuals with substance abuse disorders. 

The first Notice of Emergency and Proposed Rulemaking was adopted on October 1, 2013 effective for services rendered on or after October 1, 2013, and expired January 28, 2014.  This Notice of Second Emergency and Proposed Rulemaking was adopted on January 29, 2014 and is effective for services rendered on or after January 29, 2014.  These emergency rules will remain in effect for one hundred twenty (120) days or until May 23, 2014, unless superseded by publication of another rulemaking notice 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.

 

Subtitle A (Mental Health) of Title 22 (Health) of the DCMR is amended by adding a new Chapter 62 to read as follows:

 

CHAPTER 62           REIMBURSEMENT RATES FOR SERVICES PROVIDED BY THE DEPARTMENT OF BEHAVIORAL HEALTH CERTIFIED SUBSTANCE ABUSE PROVIDERS  

 

6200                PURPOSE

 

6200.1             This chapter establishes the reimbursement rate for services provided to eligible District residents by Department of Behavioral Health (Department) certified substance abuse providers, as this term is defined in Chapter 23 (Certification Standards for Substance Abuse Treatment Facilities and Programs) of Title 29 (Public Health) of the District of Columbia Municipal Regulations (DCMR).   

 

6200.2             Nothing in this chapter grants to a certified substance abuse provider the right to reimbursement for costs of substance abuse services and supports.  Eligibility for reimbursement is determined solely by the Human Care Agreement between the Department and the certified substance abuse provider, and reimbursement is subject to the availability of appropriated funds.

 

6201                REIMBURSEMENT RATE

 

6201.1             Reimbursement for substance abuse services shall be as follows:

 

SERVICE	CODE	RATE per        UNIT
Breathalyzer Urinalysis	H0003	15.00
Breathalyzer Specimen Collection	H0048	8.80
Case Management	H0006	20.02
Case Management (HIV)	H0006V8	20.02
Treatment Planning	T1007	22.00
Treatment Planning - Complex IP	T1007TG	24.00
Counseling Group	H0005	10.45
Counseling Group - Psycho-educational	H2027	3.51
Counseling Group - Psycho-educational (HIV)	H2027V8	3.51
Counseling On-site - Behavioral Health Therapy	H0004	20.31
Counseling, Family with Client	H0004HR	20.31
Counseling, Family without Client	H0004HS	20.31
Crisis Intervention	H0007HF	33.57
CS Peer Support Group - Substance Abuse	H0038HFHQ	8.67
CS Peer Support - Substance Abuse	H0038HF	19.19
Detoxification - Outpatient - Ambulatory	H0014	24.53
Detoxification - Residential - Acute care	H0010	605.00
Behavioral Health Screening - Determine eligibility	H0002HF	85.00
Behavioral Health Screening - Evaluate Risk Rating	H0002TG	140.00
Diagnostic Assessment - Community-Based	H0001HF	425.00
Diagnostic Assessment - Ongoing - Modify Tx Plan	H0001TS	385.00
Diagnostic Assessment - In-depth Exam - Youth	H0001HA	240.00
Diagnostic Assessment - Ongoing Follow-up - Youth	H0001HATS	85.00
Intensive Outpatient - All Inclusive	H0015	74.25
Intervention - Substance Abuse Recognition	H0022	27.17
Dose - Methadone - Clinic or Take-Home	H0020	8.58
Medication Assisted Therapy	H0020HF	8.58
Medication Management - Adult	H0016HF	35.72
Medication Management - Youth	H0016HAHF	38.96
Outpatient Therapy - Intensive	H0015HA	164.61
Prenatal Care, at-risk Assessment	H1000	142.56
Prenatal Care, at-risk enhanced service - Ante-partum Management	H1001	80.08
Prenatal Care, at-risk enhanced service - Care Coordination	H1002	80.08
Prenatal Care, at-risk enhanced service - Education	H1003	80.08
Prenatal Care, at-risk enhanced service - follow-up Home Visit	H1004	100.76
Residential - Long term Therapeutic	H0019	132.55
Residential - Long term Room & Board	H0043	72.90
Residential Treatment - Inclusive	H0018	136.84
Residential Treatment - Women w/1 child	H0019UN	210.00
Residential Treatment - Women w/2 children	H0019UP	215.00
Residential Treatment - Women w/3 children	H0019UQ	220.00
Residential Treatment - Women w/4 or more  children	H0019UR	225.00

 

 

 

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 Office of General Counsel for the Department of Behavioral Health at 64 New York Avenue, N.E., 3rd Floor, Washington, D.C. 20002, or e-mailed to Matthew Caspari, General Counsel, at [e-mail], or at telephone [phone].  Copies of the proposed rules may be obtained from dbh.dc.gov or from the Department of Behavioral Health at the address above.