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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 (2006 Repl. & 2012 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 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 (1) increase the reimbursement rate to Department of Mental Health-certified providers for the Mental Health Rehabilitation Service (MHRS) – Medication Somatic; and (2) amend the code for the Medication-Somatic service to a code which more appropriately describes the service provided. Analysis of reimbursement rates for medication somatic services or comparable services for the state of Maryland and for District of Columbia Free Standing Mental Health Clinics revealed that the previous MHRS Medication Somatic rates were the lowest and were 30% less than Medicare rates for the District of Columbia. The standard for DC Medicaid reimbursement is 80% of the DC Medicare rate. The new rate brings the MHRS rate into compliance with this methodology by increasing reimbursement rates for Medication Somatic services. Additionally, the new code for these services is entitled “medication training and support, per 15 minutes”, which best describes a Medication Somatic service.
The proposed rulemaking was published on May 31, 2013 in the D.C. Register at 60 DCR 7626 – Part 1. No comments were received and no changes have been made to the proposed rule as published. The Director took final action on the rule on July 18, 2013. This amendment will become effective on 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
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
H0034
15 minutes
$39.29 – Individual (ages 22 and over)
H0034HA
15 minutes
$42.86– Individual (ages 0 – 21)
H0034HQ
15 minutes
$21.26 – Group
Counseling
H0004
15 minutes
$19.50 – Individual On-Site
(ages 22 and over)
H0004HA
15 minutes
$20.31 – Individual On-Site
(ages 0 – 21)
H0004HQ
15 minutes
$10.45 – Group
H0004HR
15 minutes
$19.50 – Family with Consumer On-Site (ages 22 and over)
H0004HS
15 minutes
$19.50 – Family without Consumer On-Site (ages 22 and over)
H0004HAHR
15 minutes
$20.31 – Family with Consumer On-Site (ages 0 – 21)
H0004HAHS
15 minutes
$20.31 – Family without Consumer On-Site (ages 0 - 21)
H0004HE
15 minutes
$23.19 – Individual Off-Site (all ages)
Community Support
H0036
15 minutes
$19.19 – Individual
H0036HQ
15 minutes
$8.67 – Group
H0036UK
15 minutes
$19.19 – Collateral
H0036AM
15 minutes
$19.19 – Physician Team Member
H0038
H0038HQ
H0036HR
H0036HS
H0036U1
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
$19.19 – Self-Help Peer Support
$8.67 –Self-Help Peer Support Group
$19.19 – Family with Consumer
$19.19 – Family without Consumer
$19.19 – Community Residence Facility
H2023
15 minutes
$16.25 – Supported Employment (Therapeutic)
Crisis/
Emergency
H2011
15 minutes
$33.57
Day Services
H0025
One day, at least 3 hours in duration
$144.77
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
$31.35
Community-Based Intervention (Level IV – Functional Family Therapy)
H2033HU
15 minutes
$57.42
Assertive Community
H0039
15 minutes
$31.57 – Individual
Treatment
H0039HQ
15 minutes
$11.07 – Group
