4844488 Health Care Finance, Department of - Notice of Final Rulemaking - Governing Medicaid Reimbursement for Mental Health Rehabilitation Services
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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 (2012 Repl. & 2013 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) (2012 Repl.)), hereby gives notice of the adoption 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 purposes of this amendment are to update the reimbursement rates to Department of Behavioral Health-certified mental health providers for Mental Health Rehabilitation Services (MHRS). A comprehensive rate analysis had not been conducted the rates since 2001, when the Department of Mental Health – the predecessor to the Department of Behavioral Health – was first created, although some intermittent rate adjustments had been made. Thus the Department of Behavioral Health, with the assistance of providers and stakeholders, conducted a comprehensive rate review and developed a rate-setting methodology to ensure that reimbursement rates reflected the cost-basis of the services. As a result of this review, the majority of reimbursement rates for most services increased; the overall reimbursement rate will see an increase of almost fifteen percent (15%). Additionally, as a result of the rate review, the differentiation between children and adult services for Medication Treatment and for Counseling was eliminated, as the review showed no basis for such rate differential. Finally, the name for one service, Medication Somatic, was changed to Medication Training and Support to reflect the correct terminology used by the Centers for Medicaid and Medicare Services.
A Notice of Emergency and Proposed Rulemaking was published on January 17, 2014, at 61 DCR 000464. No comments have been received on these rules and no substantive changes have been made to the rules as originally published. The Director adopted these rules as final on April 4, 2014, and they will become effective upon 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
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
H0036HR
H0036HS
H0036U1
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 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
H0039
15 minutes
$38.04 – Individual
Treatment
H0039HQ
15 minutes
$11.51 – Group
