D.C. Mun. Regs. tit. 29, § 5213

Trauma Recovery and Empowerment Services

Effective Aug 2, 201360 DCR 11214Authority: 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)), 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), and Mayor’s Order 2024-115, dated July 1, 2024. Source: Final Rulemaking published at 49 DCR 4860 (May 24, 2002); as amended by Final Rulemaking published at 56 DCR 4098 (May 22, 2009); as amended by Final Rulemaking published at 56 DCR 6991 (August 28, 2009); as amended by Final Rulemaking published at 57 DCR 10521 (November 12, 2010); as amended by Emergency and Proposed Rulemaking published at 58 DCR 865 (January 28, 2011) [EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 58 DCR 4675 (May 27, 2011) [EXPIRED]; as amended by Final Rulemaking published at 58 DCR 8230 (September 23, 2011); as amended by Emergency and Proposed Rulemaking published at 58 DCR 9292 (October 28, 2011) [EXPIRED]; as amended by Final Rulemaking published at 59 DCR 1208 (February 17, 2012); as amended by Final Rulemaking published at 59 DCR 12366 (October 26, 2012); as amended by Final Rulemaking published at 60 DCR 11214 (August 2, 2013); as amended by Final Rulemaking published at 61 DCR 3997 (April 18, 2014); as amended by Final Rulemaking published at 62 DCR 3120 (March 13, 2015); as amended by Final Rulemaking published at 63 DCR 5262 (April 8, 2016); as amended by Final Rulemaking published at 63 DCR 15775 (December 23, 2016); as amended by Final Rulemaking published at 65 DCR 7837 (July 27, 2018); as amended by Final Rulemaking published at 69 DCR 012836 (October 21, 2022); as amended by Final Rulemaking published at 72 DCR 013719 (December 5, 2025).District of Columbia, Office of the Secretary

Viewing an earlier version · effective Aug 2, 2013View current

5213

REIMBURSEMENT

5213.1

Medicaid reimbursement for MHRS shall be determined as follows:

SERVICE	CODE	BILLABLE UNIT OF SERVICE	RATE
Diagnostic/ Assessment	T1023HE	An assessment, at least 3 hours in duration	$240.00
	H0002	An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program	$85.00
Medication/ Somatic Treatment	H0034	15 minutes	$39.29 – Individual (ages 22 and over)
	H0034HA	15 minutes	$42.86– Individual (ages 0 – 21)
	H0034HQ	15 minutes	$21.26 – Group
Counseling	H0004	15 minutes	$19.50 – Individual On-Site (ages 22 and over)
	H0004HA	15 minutes	$20.31 – Individual On-Site (ages 0 – 21)
	H0004HQ	15 minutes	$10.45 – Group
	H0004HR	15 minutes	$19.50 – Family with Consumer On- Site (ages 22 and over)
	H0004HS	15 minutes	$19.50 – Family without Consumer On-Site (ages 22 and over)
	H0004HAHR	15 minutes	$20.31 – Family with Consumer On- Site (ages 0 – 21)
	H0004HAHS	15 minutes	$20.31 – Family without Consumer On-Site (ages 0 - 21)
	H0004HE	15 minutes	$23.19 – Individual Off-Site (all ages)

Community Support	H0036	15 minutes	$19.19 – Individual
	H0036HQ	15 minutes	$8.67 – Group
	H0036UK	15 minutes	$19.19 – Collateral
	H0036AM	15 minutes	$19.19 – Physician Team Member
	H0038	15 minutes	$19.19 – Self-Help Peer Support
	H0038HQ	15 minutes	$8.67 –Self-Help Peer Support Group
	H0036HR	15 minutes	$19.19 – Family with Consumer
	H0036HS	15 minutes	$19.19 – Family without Consumer
	H0036U1	15 minutes	$19.19 – Community Residence Facility
	H2023	15 minutes	$16.25 – Supported Employment (Therapeutic)
Crisis/ Emergency	H2011	15 minutes	$33.57
Day Services	H0025	One day, at least 3 hours in duration	$144.77
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	$31.35
Community-Based	H2033HU	15 minutes	$57.42

Intervention

(Level IV –

Functional

Family

Therapy)

Assertive Community Treatment	H0039	15 minutes	$31.57 – Individual
	H0039HQ	15 minutes	$11.07 – Group

5213.2 DMH 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 MAA and DMH. MAA shall claim the federal share of financial participation for all MHRS services.

5213.3 Providers shall not bill the client or any member of the client's family for MHRS services. DMH shall bill all known third-party payors prior to billing the Medicaid Program.

5213.4 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 DMH-established MHRS service-specific standards; and

(k) Services furnished to a person other than the Medicaid client when those services are not directed exclusively to the well-being and benefit of the Medicaid client.

SOURCE: Final Rulemaking published at 49 DCR 4860 (May 24, 2002); as amended by Final Rulemaking published at 56 DCR 4098 (May 22, 2009); as amended by Final Rulemaking published at 56 DCR 6991 (August 28, 2009); as amended by Notice of Final Rulemaking published at 57 DCR 10521 (November 12, 2010); as amended by Notice of Emergency and Proposed Rulemaking published at 58 DCR 865 (January 28, 2011) [EXPIRED]; as amended by Notice of Emergency and Proposed Rulemaking published at 58 DCR 4675 (May 27, 2011) [EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 8230 (September 23, 2011); as amended by Notice of Emergency and Proposed Rulemaking published at 58 DCR 9292 (October 28, 2011) [EXPIRED]; as amended by Notice of Final Rulemaking published at 59 DCR 1208 (February 17, 2012); as amended by Final Rulemaking published at 59 DCR 12366 (October 26, 2012); as amended by Final Rulemaking published at 60 DCR 11214 (August 2, 2013).