3406 SERVICE COVERAGE

3406.1 MHRS are those rehabilitative services rendered through Department-certified MHRS providers to eligible consumers who meet medical necessity for such services.

3406.2 MHRS offer a continuum of care for people with complex needs through intensive, community-based services to reduce the functional impact of mental illness or serious emotional disturbance and support transitions to less intensive levels of care.

3406.3 MHRS are recommended by qualified practitioners licensed to diagnose mental illness or serious emotional disturbance. MHRS are rendered by qualified practitioners and credentialed staff, pursuant to the requirements in § 3416 and the applicable service specific standards set forth in this chapter.

3406.4 Rehabilitative services covered as MHRS are:

1. (a) Diagnostic Assessment;
2. (b) Medication/Somatic Treatment;
3. (c) Counseling;
4. (d) Community Support;
5. (e) Crisis/Emergency Services;
6. (f) Rehabilitation Day Services;
7. (g) Intensive Day Treatment (IDT);
8. (h) Community Based Intervention (CBI);
9. (i) Assertive Community Treatment (ACT);
10. (j) Psychosocial Rehabilitation Clubhouse (Clubhouse);
11. (k) Child-Parent Psychotherapy (CPP);
12. (l) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT);
13. (m) Trauma Recovery and Empowerment Model (TREM);
14. (n) Trauma Systems Therapy (TST);

(o) Clinical Care Coordination (CCC);

(p) Functional Family Therapy (FFT); and

(q) Intensive Care Coordination (ICC).

3406.5 MHRS providers are CSAs, sub-providers, and specialty providers that are certified in compliance with the standards set forth in this chapter.

3406.6 MHRS coverage limitations are set forth in §§ 3431 and 3432. Coverage for any MHRS is contingent on whether all of the following criteria are met:

(a) The service shall be medically necessary;

(b) The service shall be delivered through a certified MHRS provider;

(c) The service shall be rendered by qualified practitioners or credentialed staff pursuant to the applicable service specific standards set forth in this chapter;

(d) The service shall be delivered in accordance with an approved plan of care; and

(e) The service shall be delivered in accordance with the applicable service specific standards set forth in this chapter.

SOURCE: Final Rulemaking published at 48 DCR 10297 (November 9, 2001); as amended by Final Rulemaking published at 51 DCR 9308 (October 1, 2004); as amended by Final Rulemaking published at 52 DCR 5682 (June 17, 2005); as amended by Final Rulemaking published at 67 DCR 10674 (September 4, 2020); as amended by Final Rulemaking published at 70 DCR 003050 (March 10, 2023); as corrected by Errata Notice published at 71 DCR 004474 (April 19, 2024); as amended by Final Rulemaking published at 71 DCR 014542 (November 29, 2024).