6204137 Health Care Finance, Department of - Notice of Proposed Rulemaking - Governing Medicaid Reimbursement for Mental Health Rehabilitative Services
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DEPARTMENT OF HEALTH CARE FINANCE
NOTICE OF PROPOSED RULEMAKING
The Director of the Department of Health Care Finance (Director), 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 (2014 Repl. & 2016 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 intent to adopt an amendment to Section 5213 (Reimbursement) of Chapter 52 (Medicaid Reimbursement for Mental Health Rehabilitative Services) of Title 29 (Public Welfare) of the District of Columbia Municipal Regulations (DCMR).
This proposed rulemaking establishes a new reimbursement rate for Rehabilitation/Day Services (Rehab Day). Rehab Day is a structured clinical program offered under the Mental Health Rehabilitative Services (MHRS) program that is intended to develop skills and foster social role integration through a range of social, psycho-educational, behavioral and cognitive mental health interventions.
The Director gives notice of the 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.
Chapter 52, MEDICAID REIMBURSEMENT FOR MENTAL HEALTH REHABILITATIVE SERVICES, of Title 29 DCMR, PUBLIC WELFARE, is amended as follows:
Section 5213, REIMBURSEMENT, is amended to read as follows:
5213 REIMBURSEMENT
5213.1 Medicaid reimbursement for Mental Health Rehabilitative Services (MHRS) provided to consumers, other than consumers who are deaf or hearing-impaired, 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
H0038HS
H0038HQHS
H0036HR
H0036HS
H0036U1
15 minutes
15 minutes
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/Couple Peer Support without Consumer
$6.65 – Family/Couple Peer
Support
Group Without Consumer
$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
$116.90
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
Treatment
H0039
15 minutes
$38.04 – Individual
H0039HQ
15 minutes
$11.51 – Group
Trauma Focused Cognitive Behavioral Therapy
H004ST
15 minutes
$35.74
Child-Parent Psychotherapy for Family Violence
H004HT
15 minutes
$35.74
5213.2 Medicaid reimbursement for MHRS provided to consumers who are deaf or hearing-impaired shall be determined as follows:
SERVICE
CODE
BILLABLE UNIT
OF SERVICE
RATE
Diagnostic/
Assessment
T1023HEHK
An assessment,
at least 3 hours in duration
$345.63
H0002HK
An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program
$115.21
Medication Training& Support
H0034HK
15 minutes
$60.28 – Individual
H0034HQHK
15 minutes
$18.25 – Group
Counseling
H0004HK
15 minutes
$35.67 – Individual
H0004HQHK
15 minutes
$10.80 – Group
H0004HRHK
15 minutes
$35.67 – Family with Consumer
On-Site
H0004HSHK
15 minutes
$35.67 – Family without Consumer On-Site
Community Support
H0036HK
15 minutes
$29.66 – Individual
H0036HQHK
15 minutes
$8.98 – Group
H0036UKHK
15 minutes
$29.66 – Collateral
H0036AMHK
15 minutes
$29.66 – Physician Team Member
H0038HK
H0038HQHK
H0038HSHK
H0038HQHK
H0036HRHK
H0036HSHK
H0036U1HK
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
15 minutes
$29.66 – Self-Help Peer Support
$8.98 –Self-Help Peer Support Group
$29.66 – Family/Couple Peer Support without Consumer
$8.98 – Family/Couple Peer Support
Group Without Consumer
$29.66 – Family with Consumer
$29.66 – Family without Consumer
$29.66– Community Residence Facility
H2023HK
15 minutes
$25.12 Supported Employment (Therapeutic)
Crisis/
Emergency
H2011HK
15 minutes
$49.85
Day Services
H0025HK
One day, at least 3 hours in duration
$166.12
Intensive Day Treatment
H2012HK
One day, at least 5 hours in duration
$222.22
Community-Based Intervention (Level I – Multi-Systemic Therapy)
H2033HK
15 minutes
$77.52
Community-Based Intervention (Level II and Level III)
H2022HK
15 minutes
$48.25
Community-Based Intervention (Level IV – Functional Family Therapy)
H2033HUHK
15 minutes
$77.52
Assertive Community
Treatment
H0039HK
15 minutes
$51.35 – Individual
H0039HQHK
15 minutes
$15.54 – Group
Trauma Focused Cognitive Behavioral Therapy
H004STHK
15 minutes
$48.25
Child-Parent Psychotherapy for Family Violence
H004HTHK
15 minutes
$48.25
5213.3 The Department of Behavioral Health (DBH) shall be responsible for payment of the District's share or the local match for all MHRS in accordance with the terms and conditions set forth in the Memorandum of Understanding between Department of Health Care Finance (DHCF) and DBH. DHCF shall claim the federal share of financial participation for all MHRS services.
5213.4 Providers shall not bill the client or any member of the client's family for MHRS services. DBH shall bill all known third-party payors prior to billing the Medicaid Program.
5213.5 Medicaid reimbursement for MHRS is not available for:
(a) Room and board costs;
(b) Inpatient services (including hospital, nursing facility services, intermediate care facility for persons with mental retardation services, and Institutions for Mental Diseases services);
(c) Transportation services;
(d) Vocational services;
(e) School and educational services;
(f) Services rendered by parents or other family members;
(g) Socialization services;
(h) Screening and prevention services (other than those provided under Early and Periodic, Screening Diagnostic Treatment requirements);
(i) Services which are not medically necessary, or included in an approved Individualized Recovery Plan for adults or an Individualized Plan of Care for children and youth;
(j) Services which are not provided and documented in accordance with DBH-established MHRS service-specific standards; and
(k) Services furnished to a person other than the Medicaid client, when those services are not used exclusively for the well-being and benefit of the Medicaid client.
Comments on this proposed rulemaking shall be submitted in writing to Claudia Schlosberg, Senior Deputy Director/Medicaid Director, Department of Health Care Finance, 441 4th Street, N.W., 9th Floor, Washington, D.C. 20001, 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.