3426 ASSERTIVE COMMUNITY TREATMENT

3426.1 ACT is an intensive, integrated, rehabilitative, crisis, treatment, and mental health community support service provided by an interdisciplinary team to individuals eighteen (18) and over with serious and persistent mental illness with dedicated staff time and specific staff-to-consumer ratios.

3426.2 Service coverage by the ACT team is required twenty-four (24) hours per day, seven (7) days per week.

3426.3 The consumer's ACT team shall complete a comprehensive or supplemental assessment and develop a self-care-oriented Plan of Care (if a current and effective one does not already exist).

3426.4 Services offered by the ACT team shall include:

(a) Medication prescription, administration, and monitoring, excluding Medications for Substance Use Disorder.

(b) Crisis assessment and intervention;

(c) Symptom assessment, management, and individual supportive therapy;

(d) Substance use disorder treatment for consumers with a co-occurring substance use disorder;

(e) Psychosocial rehabilitation and skill development;

(f) Interpersonal, social, and interpersonal skill training;

(g) Education, support, and consultation to consumers' families and their support system which is directed exclusively to the well-being and benefit of the consumer;

(h) Finding safe and affordable supportive housing;

(i) Money management and benefits counseling and acquisition;

(j) Coordination of medical and psychosocial services; and

(k) Referrals and linkages to other services that address the consumer's social determinants of health.

3426.5 ACT services shall include a comprehensive and integrated set of medical and

psychosocial services for the treatment of the consumer’s mental health condition that is provided in non-office settings by the consumer’s ACT team.

3426.6 The ACT team provides community support services that are interwoven with treatment and rehabilitative services and regularly scheduled team meetings. ACT team meetings shall be held a minimum of four (4) times a week.3426.7 ACT services and interventions shall be highly individualized and tailored to the needs and preferences of the consumer, with the goal of maximizing independence and supporting recovery.3426.8 Each ACT provider shall have policies and procedures included in its Service Specific Policies that address the provisions of ACT ('ACT Organizational Plan') which include the following:- (a) A description of the particular treatment models utilized, types of intervention practiced, and typical daily curriculum and schedule; and

- (b) A description of the staffing pattern and how staff are deployed to ensure that the required staff-to-consumer ratios are maintained, including how unplanned staff absences and illnesses are accommodated.3426.9 At a minimum, the ACT team shall include the following members:- (a) A full-time team leader or supervisor who is the clinical and administrative supervisor of the Assertive Community Treatment (ACT) team and who is at minimum an independently licensed qualified practitioner;

- (b) A psychiatrist or a psychiatric prescriber working on a full-time or part-time basis for a minimum of four (4) hours per week per twenty (20) consumers, who provides clinical and crisis services to all consumers served by the ACT team, works with the ACT team leader to monitor each consumer's clinical status and response to treatment, and directs psychopharmacologic and medical treatment;

- (c) An RN working on a full-time basis, who provides nursing services for all ACT team consumers. The RN works with the ACT team to monitor each consumer's clinical status and response to treatment, and who functions as a primary practitioner on the ACT team for a caseload of consumers;

- (d) A certified addiction counselor who is working on a full-time basis and providing or accessing substance use disorder services for ACT team consumers, and who functions as a primary practitioner on the ACT team for a caseload of consumers;

1. (e) A clinically trained and licensed generalist practitioner working on a full-time basis and providing individual and group supportive therapy to ACT team consumers, and who functions as a primary practitioner on the ACT team for a caseload of consumers and is a qualified practitioner;
2. (f) A certified recovery coach or certified peer specialist carrying out rehabilitation and support functions who may be a consumer in recovery that has been specially credentialed based on their psychiatric and life experiences. Certified recovery coaches and certified peer specialists are fully integrated ACT team members who provide consultation to the ACT team and highly individualized services in the community, and who promote consumer self-determination and decision making; and
3. (g) A vocational specialist with at least one year of training or experience who has knowledge of supported employment, vocational assessment, job exploration and marketing to recipient's interest and strengths and securing and maintain employment.3426.10 The ACT team shall maintain a minimum consumer-to-staff ratio of no more than ten (10) consumers per staff person, and such ratio shall take into consideration evening and weekend hours, needs of special populations, and geographical areas to be covered.3426.11 Eligible providers of ACT services shall:- (a) Utilize the ACT model adopted by the Department;
4. (b) Meet ACT training requirements specified by the Department; and
5. (c) Have culturally and linguistically competent staff.3426.12 ACT shall require prior authorization from the Department. Initial and subsequent authorizations shall not exceed six (6) calendar months.3426.13 ACT consumers shall receive vocational and supported employment services through their ACT team. ACT consumers shall not be eligible for Supported Employment services that are subject to the Supported Employment program standards set forth in 22-A DCMR Chapter 37.3426.14 ACT shall not be billed on the same day as:- (a) Diagnostic Assessment;

(b) Medication/Somatic Treatment;

(c) Counseling;

(d) Community Support;

(e) Intensive Day Treatment (IDT);

(f) Community Based Intervention (CBI);

(g) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT);

(h) Trauma Recovery and Empowerment Model (TREM);

(i) Trauma Systems Therapy (TST); or

(j) Functional Family Therapy (FFT).

3426.15 ACT providers shall not bill Crisis/Emergency Services when provided to one of their current consumers.

3426.16 Assertive Community Treatment (ACT) shall be provided:

(a) At the Mental Health Rehabilitation Service (MHRS) provider's service site; or

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

(c) Through telehealth pursuant to Title 29 DCMR § 910 as permitted by § 3426.21.

3426.17 The following are qualified practitioners of ACT:

(a) Psychiatrists;

(b) Psychologists;

(c) LICSWs;

(d) APRNs;

(e) LPCs;

(f) LMFTs;

(g) RNs;

(h) LGSWs;

(i) LGPCs;

(j) LISWs;

(k) Psychology Associates;

(l) PAs; and

(m) Certified Addiction Counselors (“CAC”) I and II.

3426.18 Credentialed staff shall be permitted to provide ACT service components under the supervision of an independently licensed qualified practitioner.

3426.19 ACT providers shall be reimbursed at a monthly rate established by the Department of Health Care Finance on the Medicaid Fee Schedule (available at https://dhcf.dc.gov/). ACT providers must document a minimum of five (5) contacts delivered to or on behalf of a consumer per calendar month and meet the requirements of § 3426.20 through § 3426.23 to receive the monthly rate for the consumer. ACT providers must document all services delivered to a consumer pursuant to § 3413.19, including those in excess of five (5) contacts per calendar month. ACT providers may submit up to (2) contacts per day in support of the five (5) contacts per calendar month.

3426.20 The following activities by the provider shall constitute one (1) contact each:

(a) Daily team meeting – The ACT provider must record each daily team meeting in each consumer’s electronic health record and may submit one (1) daily team meeting per consumer as a contact per calendar month;

(b) Contact with an Advanced Practice Registered Nurse (APRN) or Medical Doctor (MD) – The ACT provider must ensure that each consumer has at least one (1) scheduled appointment per calendar month with an APRN or MD. The ACT provider must document whether a consumer attends the scheduled APRN or MD appointment in the consumer’s electronic health record. There shall be no penalty against an ACT provider if a consumer fails to attend the APRN or MD meeting; however, missed APRN or MD appointments shall not constitute a contact. The APRN or MD contact must be delivered directly to the consumer. Collateral contacts initiated by

the APRN or MD and daily team meetings attended by the APRN or MD shall not be sufficient to meet this requirement;

(c) Any face-to-face contact with a member of the ACT team during which the ACT team member delivers services consistent with the consumer's Individual Plan of Care;

(d) A crisis/emergency service;

(e) Hospital engagement including but not limited to face-to-face contact with the consumer or a collateral contact with the hospital social worker, the psychiatrist, or the discharge planning team;

(f) A contact with a consumer's natural support;

(g) Psychotherapy services;

(h) Psychoeducation services delivered to the consumer or to their natural support;

(j) Independent skills teaching;

(k) Case management episode;

(l) Engagement episode; and

(m) Collateral contact.

3426.21 The provider must ensure that the five (5) contacts per calendar month to or on behalf of a consumer, as specified in § 3426.19, that are submitted in support of the provider's billing meet the following:

(a) A minimum of three (3) contacts must be delivered to a consumer in person.

(b) A minimum of two (2) contacts must be delivered by a qualified practitioner either in person or via audio or audio-visual telehealth pursuant to 29 DCMR § 910.

(c) A maximum of two (2) collateral contacts may be delivered in a month. Collateral contacts may be delivered via audio or audio-visual telehealth pursuant to 29 DCMR § 910.

3426.22 Reimbursement for ACT services shall be contingent on the following:

(a) The provider must document at least five (5) contacts provided to or on behalf of a consumer during a calendar month;

(b) The service must be prior authorized by the payer;

(c) The service must be medically necessary;

(d) The service must be delivered by an ACT provider certified by the Department of Behavioral Health;

(e) All services must be delivered by qualified practitioners pursuant to § 3426.17 or credentialed staff pursuant to § 3426.18;

(f) The service must be delivered in accordance with the consumer's Individual Plan of Care; and

(g) The service must be delivered in accordance with all applicable provisions of this Chapter.

3426.23 The ACT provider must ensure that each contact includes the rendering provider's National Provider Identification Number, the name of the provider organization/group, the date of service, the length of service, the place of service, and the modality of service.

SOURCE: Final Rulemaking published at 61 DCR 5415 (May 30, 2014); 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 70 DCR 003050 (March 10, 2023); as amended by Final Rulemaking published at 70 DCR 016660 (December 29, 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); as amended by Final Rulemaking published at 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).