3421.1 Community Support services are rehabilitation and environmental supports considered essential to assist the consumer in achieving rehabilitation and recovery goals that focus on building and maintaining a therapeutic relationship with the consumer.

3421.2 Community Support services include but are not limited to:

1. (a) Participation in the development and implementation of a consumer's Plan of Care;
2. (b) Assistance and support for the consumer in stressor situations;
3. (c) Mental health education, support, and consultation to consumers' families and support systems directed exclusively to the well-being and benefit of the consumer;
4. (d) Individual mental health intervention for the development of interpersonal and community coping skills, including adapting to home, school, and work environments;
5. (e) Assistance to the consumer in symptom self-monitoring and self-management to identify and minimize the negative effects of psychiatric symptoms, which interfere with the consumer's daily living, financial management, personal development, or school or work performance;
6. (f) Assistance to the consumer in increasing social support skills and networks that ameliorate life stresses resulting from the consumer's mental illness or emotional disturbance and which are necessary to enable and maintain the consumer's independent living;
7. (g) Development of strategies and supportive mental health intervention to avoid out-of-home placement for adults, children, and youth and to build stronger family support skills and knowledge of the adult's, child's, or youth's strengths and limitations;
8. (h) Development of mental health relapse prevention strategies and plans; and
9. (i) Assistance with coordination of any substance use disorders, co-occurring disorders, and primary care needs.

3421.3 Community Support services may be provided by a team of staff that is responsible for an assigned group of consumers, or by staff who are individually responsible for assigned consumers.

3421.4 The Community Support provider shall maintain a staff-to-consumer ratio of no less than one (1) staff person for every twenty (20) consumers for children and youth, and one (1) staff person for every forty (40) consumers for adults.

3421.5 Community Support services provided to children and youth shall include coordination with family and significant others and with other systems of care, such as education, managed health plans (including Medicaid managed care plans), juvenile justice, and children's protective services, when appropriate to treatment and recovery needs.

3421.6 Authorization limits for Community Support services shall be as follows:

(a) Community Support services shall require prior authorization.

(b) The District shall reimburse no more than six (6) units of Community Support services per day.

(c) The number of units a consumer may receive per one hundred and eighty (180) calendar day period shall be as follows:

DLA-20 Score	CAFAS/PECFAS Score	Number of Allowable Units	Number of Allowable Supplemental Units
1.0-3.0	120+	0	0
3.1-4.0	80-110	200	50
4.1-5.0	50-70	100	25
5.1+	0-40	0	0

3421.7 Community Support shall not be billed on the same day as ACT.

3421.8 Individual Community Support shall not be billed during a Rehabilitation Day Services encounter.

3421.9 Group Community Support shall not be billed on the same day as Rehabilitation Day Services.

3421.10 Community Support services shall be provided:

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

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

(c) In a residential facility of sixteen (16) beds or fewer unless otherwise authorized by the Department pursuant to the Department's billing manual; or

(d) Via audio-only or audio-visual telemedicine pursuant to Title 29 DCMR § 910. Audio-only Community Support telemedicine services are limited to six (6) units per one hundred eighty (180) day period, unless otherwise authorized by the Department pursuant to the Department's billing manual. Notwithstanding the foregoing sentence, providers may bill up to an additional twenty (20) audio-only Community Support telemedicine units per consumer per one hundred eighty (180) day period for collateral contacts.

3421.11 Subsections 3421.3 through 3421.9 shall not apply to Therapeutic Supported Employment services, as defined in 22-A DCMR Chapter 37, which are provided as Community Support services. Therapeutic Supported Employment services are reimbursed pursuant to any applicable authorization requirements and billing limitations set forth in 22-A DCMR Chapter 37.

3421.12 The following are qualified practitioners of Community Support:

(a) Psychiatrists;

(b) Psychologists;

(c) LICSWs;

(d) APRNs;

(e) LISWs;

(f) LPCs;

(g) RNs;

(h) LMFTs;

(i) LGSWs;

(j) LGPCs;

(k) Psychology Associates; and

(l) PAs.

3421.13 Credentialed staff shall be permitted to provide Community Support under the supervision of an independently licensed qualified practitioner.

3421.14 To qualify for Community Support services, a consumer shall meet the following clinical necessity criteria, as determined by an independently licensed qualified practitioner pursuant to § 3418:

(a) A Diagnostic Assessment of the consumer has been performed within twelve (12) months of the request for Community Support services that contains at least one (1) of the following primary diagnoses:

(1) Schizophrenia Spectrum, Delusional, or Other Psychotic Disorders;

(2) Affective (Mood) Disorders;

(3) Trauma and Stressor Related Disorders;

(4) Obsessive-Compulsive and Related Disorders;

(5) Personality Disorders; or

(6) Anxiety-Related Disorders;

(b) A functional assessment of the consumer has been performed within one hundred and eighty (180) calendar days before the request for Community Support services that documents significant impairment in the consumer’s ability to perform skills necessary for independent functioning in the community due to the consumer’s diagnosis that meets the requirements of § 3421.6(c).

(c) The consumer, or a legal guardian, has agreed to receive Community Support services and is capable of developing the skills to manage symptoms and make behavioral changes; and

(d) A current Plan of Care has been created within one hundred and eighty (180) calendar days before the request for Community Support services that clearly identifies interventions, services, and benefits to be performed and coordinated through Community Support services.

3421.15 Community Support services provided in accordance with § 3421.6 for subsequent one hundred and eighty (180) calendar day periods shall require

authorization from the Department, and the consumer must continue to meet the criteria in § 3421.14 and must meet one (1) or more of the following clinical necessity criteria, as determined by a qualified practitioner pursuant to § 3421.12:

(a) Improvement in one (1) or more areas on the designated functional assessment tool;

(b) Maintenance or stabilization of functioning in daily life, with no observed or reported regression or exacerbation of symptoms; or

(c) Achievement of or progress toward Plan of Care goals.

3421.16 Community Support services provided in excess of the units authorized by § 3421.6 in each one hundred and eighty (180) calendar day period, shall require supplemental authorization from the Department.

(a) With the request for supplemental authorization, the provider shall submit a clinical summary signed by a qualified practitioner that demonstrates why additional units of Community Support are needed to address the change in the consumer's behavioral health and how the additional units of Community Support will support the Plan of Care goals.

(b) No request for supplemental authorization shall be granted unless the consumer continues to meet the clinical necessity criteria in § 3421.14 and there is a demonstrated clinical need for additional units based on the qualified practitioner's clinical summary and the following:

(1) A decline in two (2) or more areas on the designated functional assessment tool; or

(2) The consumer experienced a significant event impacting their independent functioning in the community within thirty (30) calendar days before the request for supplemental authorization is submitted, such as a hospitalization, a loss of housing, use of crisis/emergency services, or an arrest or incarceration.

3421.17 Audio-only Community Support services provided in excess of the audio-only units authorized in § 3421.10(d) shall require prior authorization from the Department. No request for additional units shall be granted unless there is a demonstrated clinical need for additional units based upon the need to increase coordination with collateral contacts due to a significant change in the consumer's behavioral health as described in § 3421.16.

3421.18 Providers shall not provide Community Support services to consumers unless

clinically necessary as set forth in this section. Consumers who require more intensive services shall be assessed for a higher level of care. Consumers who no longer clinically require Community Support services shall be transitioned to a lower level of care.

3421.19 The Department or its designee shall provide the provider and the consumer written notice of any denial of Community Support authorization. The provider or consumer may request an administrative review by the Department within fourteen (14) calendar days of the notice.

3421.20 The Department shall promptly review a request for administrative review and provide a final written decision within fourteen (14) calendar days of the request. The provider or consumer may appeal a final decision denying Community Support authorization to the Office of Administrative Hearings pursuant to the fair hearing procedures in Title 29 DCMR § 9508.

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 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 67 DCR 10674 (September 4, 2020); as amended by Final Rulemaking 68 DCR 012400 (November 26, 2021); as amended by Final Rulemaking 72 DCR 002797 (March 14, 2025); as amended by Final Rulemaking published at 72 DCR 008497 (August 1, 2025); as amended by Final Rulemaking published at 72 DCR 014041 (December 19, 2025); as amended by Final Rulemaking published at 73 DCR 007822 (May 22, 2026).