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DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF 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 (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 the intent to adopt 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 proposed rule is to set forth the billing rate for the Mental Health Rehabilitation Service - Community-Support – Supported Employment services. Supported Employment services are provided by certified Supported Employment providers to individuals who suffer from mental illness and need supports to become prepared for, and maintain, employment. Supported Employment services that are therapeutic supportive services, rather than vocational services, are reimbursable through Medicaid as a Community Support service. Previously all of these services were funded through local District funding; however, once final rules are published, Supported Employment services that are therapeutic supportive services may be funded as a Medicaid-reimbursable service. Thus, this rule reflects the appropriate code and reimbursement rate for that service. The new reimbursement rate is the same as the rate that was paid using local District funds.
These proposed rules also includes certain billing code modifiers to further clarify the exact Community Support and Counseling service being provided, corrects the code for Intensive Day Treatment, and deletes the payment rates that became obsolete as of October 1, 2011.
The Director also gives notice of intent to take final rulemaking action to adopt the proposed rule 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, 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
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)
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
Comments on this proposed rulemaking shall be submitted in writing to Linda Elam, PhD., MPH, Deputy Director, Department of Health Care Finance, 899 North Capitol Street, NE, 6th Floor, Washington, DC 20002, via email to DHCFPubliccomments@dc.gov, online at www.dcregs.dc.gov, or by telephone to (202) 442-9115, 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.
