D.C. Mun. Regs. tit. 29, § 5213
5213.1 Effective May 1, 2018, reimbursement for Mental Health Rehabilitative Services (MHRS) shall be made according to the District of Columbia Medicaid fee schedule available online at www.dc-medicaid.com. All future updates to the reimbursement rates for MHRS services shall comply with the public notice requirements set forth under Section 988 of Chapter 9 of Title 29 of the District of Columbia Municipal Regulations (DCMR).
5213.1 A public notice of MHRS rate changes shall be published in the D.C. Register at least thirty (30) calendar days in advance of the change, and shall include a link to the Medicaid fee schedule.
5213.2 Medicaid reimbursement for MHRS provided to beneficiaries, other than beneficiaries who are deaf or hard of hearing, 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 |
| SERVICE | CODE | BILLABLE UNIT OF SERVICE | RATE |
|---|---|---|---|
| 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 Day Services | H2011 | 15 minutes | $59.18 |
| H0025 | One day, at least 3 | $116.90 |
| hours in duration | |||
|---|---|---|---|
| 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 |
| SERVICE | CODE | BILLABLE UNIT OF SERVICE | RATE |
|---|---|---|---|
| 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 Focused Cognitive Behavioral Therapy | H004ST | 15 minutes | $35.74 |
| Child-Parent Psychotherapy for Family Violence | H004HT | 15 minutes | $35.74 |
5213.3 Medicaid reimbursement for MHRS provided to beneficiaries who are deaf or hard of hearing shall be determined as follows:
| SERVICE | CODE | BILLABLE UNIT OF SERVICE | RATE |
|---|---|---|---|
| Diagnostic/ Assessment | T1023HEHK | An assessment, at least 3 hours in Public Welfare | $345.63 |
| duration | |||
|---|---|---|---|
| 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 without Consumer On-Site | |
| Community Support | 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 |
| H0038HSHK | 15 minutes | $8.98 –Self-Help Peer Support Group | |
|---|---|---|---|
| H0038HQHK | 15 minutes | $29.66 – Family/Couple Peer Support without Consumer | |
| H0036HRHK | 15 minutes | ||
| H0036HSHK | 15 minutes | ||
| H0036U1HK | 15 minutes | $8.98 – Family/Couple Peer Support Group Without Consumer | |
| 15 minutes | $29.66 – Family with Consumer | ||
| 15 minutes | $29.66 – Family without Consumer | ||
| 15 minutes | $29.66– Community Residence Facility | ||
| H2023HK | 15 minutes | $25.12 Supported Employment (Therapeutic) | |
| Crisis/ Emergency | H2011HK | 15 minutes | $59.18 |
| 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 |
5213.4 The Department of Behavioral Health (DBH) shall be responsible for payment of the non-federal share of total expenditures under the District of Columbia Medicaid State Plan (State Plan), 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.
5213.5 DHCF shall claim the federal share of Medicaid financial participation, or the federal match, for all MHRS services.5213.6 MHRS providers shall not bill the Medicaid beneficiary or any member of the Medicaid beneficiary's family for MHRS services.5213.7 In accordance with the Medicaid third-party liability requirements set forth under 42 CFR Part 433 and outlined in the District of Columbia Medicaid State Plan, DBH shall bill all known third-party payors prior to billing the Medicaid Program.5213.9 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); as amended by Final Rulemaking published at 65 DCR 7837 (July 27, 2018).