3418.1 A Diagnostic Assessment is an intensive clinical and functional evaluation of a consumer's mental health condition that results in the issuance of a Diagnostic Assessment report, including a clinical formulation, with recommendations for service delivery that provides the basis for and includes the development of a Plan of Care. A psychiatrist shall supervise and coordinate all psychiatric and medical functions required by a consumer's Diagnostic Assessment.

3418.2 A Diagnostic Assessment shall:

1. (a) Determine whether the consumer is appropriate for and can benefit from MHRS based upon the consumer's diagnosis, presenting problems, and recovery goals;
2. (b) Evaluate the consumer's level of readiness and motivation to engage in treatment;
3. (c) Include the development of a Plan of Care; and
4. (d) Screen and assess consumers for EBP and Mental Health Supported Employment services as appropriate and applicable.

3418.3 An initial Diagnostic Assessment shall be performed by an independently licensed qualified practitioner for each consumer being considered for enrollment with a CSA.

3418.4 The Diagnostic Assessment shall include the following elements:

1. (a) A chronological behavioral health history of the consumer's symptoms, treatment, treatment response, and attitudes about treatment and recovery, emphasizing factors that have contributed to or inhibited previous recovery efforts;
2. (b) For youth and adults, the chronological behavioral health history shall include both psychiatric history and substance use disorder history, treatment history for either or both diagnoses, and the consumer's perception of the outcome;
3. (c) Biological, psychological, familial, social, and environmental dimensions, and identified strengths and weaknesses in each area;
4. (d) A description of the presenting problem(s), including source of distress, precipitating events, associated problems or symptoms, and recent

progression;

(e) Both a strengths summary and a problem summary, which address the following:

(1) Risk of harm;

(2) Functional status, including relevant emotional and behavioral conditions or complications, and self-control, self-care and interpersonal abilities, coping, and independent living skills;

(3) Co-morbidity, including biomedical conditions and complications;

(4) Recovery environment, including supports and stressors; and

(5) Treatment and recovery history, including relapse potential.

(f) Diagnoses in the DSM-5 or any subsequent version adopted by the Department pursuant to written notice published in the District of Columbia Register;

(g) A review of the consumer's substance use history and presenting problem(s), including an assessment of substances used and intensity of use, the likelihood and severity of withdrawal, and the medical and behavioral risks secondary to intoxication. This review shall identify or exclude substance use disorder as a co-occurring treatment need;

(h) Assessment of the need for psychiatric hospitalization for consumers referred to psychiatric inpatient services to assure that less restrictive alternatives are considered and used when appropriate; and

(i) Evidence of consumer participation and including families' or guardians' participation if appropriate.

3418.5 The Diagnostic Assessment may include psychological testing.

3418.6 Following the completion of the Diagnostic Assessment, an interpretative clinical summary of findings and recommendations for treatment shall be listed in a Diagnostic Assessment report. A Diagnostic Assessment report shall identify barriers to be addressed during treatment and recovery to reduce or eliminate

identified deficits.

3418.7 The independently licensed qualified practitioner that performed the Diagnostic Assessment shall complete the Diagnostic Assessment report no later than ten (10) business days after completing the Diagnostic Assessment. The results of the Diagnostic Assessment shall be incorporated into the Plan of Care.

3418.8 A qualified practitioner shall convene the consumer, and the consumer's family and significant others, if appropriate, to review the Diagnostic Assessment report and develop the Plan of Care.

3418.9 One (1) Diagnostic Assessment shall be allowable every one hundred and eighty (180) calendar days. Additional units of Diagnostic Assessment shall be allowable with prior authorization by the Department when there is a significant change in the consumer's mental health status.

3418.10 Diagnostic Assessment shall not be billed on the same day as ACT.

3418.11 Diagnostic Assessment services shall be provided:

(a) At the MHRS provider's service site;

(b) In natural settings, including the consumer's home or community setting; or

(c) In a residential facility of sixteen (16) beds or less unless otherwise stated by the Department.

3418.12 The following are qualified practitioners of Diagnostic Assessment who are permitted to screen, assess, and diagnose:

(a) Psychiatrists;

(b) Psychologists;

(c) Licensed Independent Clinical Social Workers (LICSW);

(d) APRNs;

(e) Licensed Professional Counselor (LPC);

(f) Licensed Marriage and Family Therapist (LMFT);

(g) Licensed Graduate Professional Counselor (LGPC);

(h) Licensed Graduate Social Worker (LGSW); and

(i) PAs.

3418.13 The following are qualified practitioners permitted to provide screening and assessment services as part of a Diagnostic Assessment, but are not permitted to diagnose:

(a) Registered Nurses (RN);

(b) LISWs; and

(c) Psychology Associates.

3418.14 Credentialed staff shall be permitted to provide screening services as a part of a Diagnostic Assessment under the supervision of an independently licensed qualified practitioner permitted to diagnose mental illness.

3418.15 MHRS providers shall complete a functional assessment utilizing the Department’s designated functional assessment tools for consumers within the following timelines and incorporate its findings into the Plan of Care:

(a) At intake for adults;

(b) For children/youth, within thirty (30) calendar days of intake or by the fourth (4th) visit, whichever comes first;

(c) Every ninety (90) calendar days after any consumer’s initial assessment, and every ninety (90) calendar days thereafter;

(d) Upon events that may affect any consumer’s functioning and may require a change in the consumer’s treatment plan and/or service acuity; and

(e) For all consumers, at discharge.

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 Emergency and Proposed Rulemaking published at 57 DCR 4010 (May 7, 2010)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 57 DCR 7734 (August 20, 2010)[EXPIRED]; as amended by Final Rulemaking published at 57 DCR 8698 (September 24, 2010); as amended by Notice of Emergency and Proposed Rulemaking published at 58 DCR 1482 (February 18, 2011)[EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 3476, 3479 (April 22, 2011); as amended by Final Rulemaking published at 66 DCR 5638 (May 3, 2019); as amended by Final Rulemaking published at 67 DCR

10674 (September 4, 2020); as amended by Final Rulemaking 68 DCR 012400 (November 26, 2021); as amended by Final Rulemaking published at 72 DCR 008497 (August 1, 2025).