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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.; 2011 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 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 purpose of these amended rules is to (1) set forth the new billing rates for Assertive Community Treatment (ACT) and Community Support – Individual to reflect rate reductions for fiscal year 2011 and (2) to set forth the new billing rates for ACT and Community Support – Individual to reflect the revised rates for fiscal year 2012. The 2011 rates became effective February 1, 2011, covering only eight (8) months of billing at the new rate for fiscal year 2011; therefore, a higher rate cut from the 2010 rates will occur for fiscal year 2011 than will occur for fiscal year 2012, since the fiscal year 2012 rates cover twelve (12) months of billing at the new rate. Thus, the fiscal year 2011 rates reflect a seven and half percent (7.5%) reduction from the 2010 rates, while the fiscal year 2012 rates reflect a five percent (5%) reduction from the 2010 rates. The fiscal year 2012 rates will become effective October 1, 2011.
A Notice of Emergency and Proposed Rulemaking was published in the D.C. Register on January 28, 2011 (58 DCR 865). One comment was received noting a needed correction for the date that the fiscal year 2012 rates will become effective. Therefore a Second Notice of Emergency and Proposed Rulemaking was published in the D.C. Register on May 27, 2011 (58 DCR 4675). No comments have been received in response to the Second Notice of Emergency and Proposed Rulemaking and no substantive changes have been made.
This final rule was adopted on August 26, 2011, and will become effective upon publication 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:
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
EFFECTIVE
FEB. 1, 2011
RATE
EFFECTIVE
OCT. 1, 2011
Diagnostic/
Assessment
T1023HE
An assessment,
at least 3
$240.00
$240.00
hours in duration
H0002
An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program
$85.00
$85.00
Medication/
Somatic Treatment
T1502
15 minutes
$35.72 –
Individual
(ages 22 and over)
$35.72 –
Individual
(ages 22 and over)
T1502HA
15 minutes
$38.96 –
Individual
(ages 0 – 21)
$38.96 –
Individual
(ages 0 – 21)
T1502HQ
15 minutes
$19.33 – Group
$19.33 –
Group
Counseling
H0004
15 minutes
$19.50
Individual
On-site
(ages 22 and
over)
$19.50
Individual
On-Site
(ages 22 and over)
H004HA
15 minutes
$20.31 –
Individual
On-Site
(ages 0 – 21)
$20.31 –
Individual
On-Site
(ages 0 – 21)
H004HQ
15 minutes
$10.45 – Group
$10.45 –
Group
Community Support
H0036
15 minutes
$18.59
Individual
$19.19
Individual
H0036HQ
15 minutes
$8.67 Group
$8.67 Group
Crisis/
Emergency
H2011
15 minutes
$33.57
$33.57
Day Services
H0025
One day, at least 3 hours in duration
$144.77
$144.77
Intensive Day Treatment
H2021
One day, at least 5 hours in duration
$164.61
$164.61
Community-Based Intervention (Level I)
H2033
15 minutes
$57.42
$57.42
Community-Based Intervention (Level II and Level III)
H2022
15 minutes
$31.35
$31.35
Assertive Community
H0039
15 minutes
$30.74
Individual
$31.57
Individual
Treatment
H0039HQ
15 minutes
$11.07 Group
$11.07 Group
