D.C. Mun. Regs. tit. 29, § 5213
5213.1 Medicaid reimbursement for Mental Health Rehabilitative Services (MHRS) provided to consumers, other than consumers who are deaf or hearing-impaired, shall be determined as follows:
| SERVICE | CODE | BILLABLE UNIT OF SERVICE | RATE |
|---|---|---|---|
| Diagnostic/ Assessment | T1023HE | An assessment, at least 3 hours in duration | $256.02 |
| H0002 | An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program | $85.34 | |
| Medication Training& Support | H0034 | 15 minutes | $44.65 – Individual |
| H0034HQ | 15 minutes | $13.52 – Group | |
| Counseling | H0004 | 15 minutes | $26.42 – Individual |
| H0004HQ | 15 minutes | $8.00 – Group | |
| H0004HR | 15 minutes | $26.42 – Family with Consumer On-Site | |
| H0004HS | 15 minutes | $26.42 – Family without Consumer On-Site | |
| H0004HETN | 15 minutes | $27.45 – Individual Off-Site |
| Community Support | H0036 | 15 minutes | $21.97 – Individual |
|---|---|---|---|
| H0036HQ | 15 minutes | $6.65 – Group | |
| H0036UK | 15 minutes | $21.97 – Collateral | |
| H0036AM | 15 minutes | $21.97 – Physician Team Member | |
| H0038 | 15 minutes | $21.97 – Self- Help Peer Support | |
| H0038HQ | 15 minutes | $6.65 –Self- Help Peer Support Group | |
| H0038HS | 15 minutes | $21.97 – Family/Couple Peer Support without Consumer | |
| H0038HQHS | 15 minutes | $6.65 – Family/Couple Peer Support Group Without Consumer | |
| H0036HR | 15 minutes | $21.97 – Family with Consumer | |
| H0036HS | 15 minutes | $21.97 – Family without Consumer | |
| H0036U1 | 15 minutes | $21.97– Community Residence Facility |
| H2023 | 15 minutes | $18.61– Supported Employment (Therapeutic) | |
|---|---|---|---|
| Crisis/ Emergency | H2011 | 15 minutes | $36.93 |
| Day Services | H0025 | One day, at least 3 hours in duration | $116.90 |
| 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 | $35.74 |
| Community- Based Intervention (Level IV – Functional Family Therapy) | H2033HU | 15 minutes | $57.42 |
| Assertive Community Treatment | H0039 | 15 minutes | $38.04 – Individual |
| H0039HQ | 15 minutes | $11.51 – Group | |
| Trauma | H004ST | 15 minutes | $35.74 |
Focused
Cognitive
Behavioral
Therapy
Child-Parent
Psychotherapy
for Family
Violence
H004HT
15 minutes
$35.74
5213.2 Medicaid reimbursement for MHRS provided to consumers who are deaf or hearing-impaired shall be determined as follows:
| SERVICE | CODE | BILLABLE UNIT OF SERVICE | RATE |
|---|---|---|---|
| Diagnostic/ Assessment | T1023HEHK | An assessment, at least 3 hours in duration | $345.63 |
| H0002HK | An assessment, 40 – 50 minutes in duration to determine eligibility for admission to a mental health treatment program | $115.21 | |
| Medication Training & Support | H0034HK | 15 minutes | $60.28 – Individual |
| H0034HQHK | 15 minutes | $18.25 – Group | |
| Counseling | H0004HK | 15 minutes | $35.67 – Individual |
| H0004HQHK | 15 minutes | $10.80 – Group | |
| H0004HRHK | 15 minutes | $35.67 – Family with Consumer On-Site | |
| H0004HSHK | 15 minutes | $35.67 – Family |
| Community Support | without Consumer On- Site | ||
|---|---|---|---|
| H0036HK | 15 minutes | $29.66 – Individual | |
| H0036HQHK | 15 minutes | $8.98 – Group | |
| H0036UKHK | 15 minutes | $29.66 – Collateral | |
| H0036AMHK | 15 minutes | $29.66 – Physician Team Member | |
| H0038HK | 15 minutes | $29.66 – Self- Help Peer Support | |
| H0038HQHK | 15 minutes | $8.98 –Self-Help Peer Support Group | |
| H0038HSHK | 15 minutes | $29.66 – Family/Couple Peer Support without Consumer | |
| H0038HQHK | 15 minutes | $8.98 – Family/Couple Peer Support Group Without Consumer | |
| H0036HRHK | 15 minutes | $29.66 – Family with Consumer | |
| H0036HSHK | 15 minutes | $29.66 – Family without Consumer | |
| H0036U1HK | 15 minutes | $29.66– Community |
| Residence Facility | |||
|---|---|---|---|
| H2023HK | 15 minutes | $25.12 Supported Employment (Therapeutic) | |
| Crisis/ Emergency | H2011HK | 15 minutes | $49.85 |
| Day Services | H0025HK | One day, at least 3 hours in duration | $166.12 |
| Intensive Day Treatment | H2012HK | One day, at least 5 hours in duration | $222.22 |
| Community- Based Intervention (Level I – Multi-Systemic Therapy) | H2033HK | 15 minutes | $77.52 |
| Community- Based Intervention (Level II and Level III) | H2022HK | 15 minutes | $48.25 |
| Community- Based Intervention (Level IV – Functional Family Therapy) | H2033HUHK | 15 minutes | $77.52 |
| Assertive Community Treatment | H0039HK | 15 minutes | $51.35 – Individual |
| H0039HQHK | 15 minutes | $15.54 – Group |
| Trauma Focused Cognitive Behavioral Therapy | H004STHK | 15 minutes | $48.25 |
|---|---|---|---|
| Child-Parent Psychotherapy for Family Violence | H004HTHK | 15 minutes | $48.25 |
5213.3 The Department of Behavioral Health (DBH) 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 Department of Health Care Finance (DHCF) and DBH. DHCF shall claim the federal share of financial participation for all MHRS services.
5213.4 Providers shall not bill the client or any member of the client's family for MHRS services. DBH shall bill all known third-party payors prior to billing the Medicaid Program.
5213.5 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 DBH-established MHRS service-specific standards; and
(k) Services furnished to a person other than the Medicaid client, when those services are not used exclusively for 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 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).