8609 PROGRAM SERVICES: LICENSED BEHAVIORAL HEALTH PRACTITIONERS

8609.1 Effective January 1, 2020, the following licensed behavioral health providers shall be eligible to enroll in the District of Columbia Medicaid Program and provide behavioral health services, regardless of program affiliation:

1. (a) Psychologists;
2. (b) Licensed Independent Clinical Social Workers;
3. (c) Licensed Professional Counselors; and
4. (d) Licensed Marriage and Family Therapists.

8609.2 Medicaid reimbursement will be available for the following services, when provided to an eligible Medicaid beneficiary by a licensed behavioral health practitioner identified in § 8609.1, practicing within the scope of their licensure, in accordance with requirements set forth under the District of Columbia Health Occupations Revision Act of 1985, District of Columbia Official Code Title 3, Chapter 12 §§ 3-1201.01 – 3-1213.13, 3-1251.01 – 3.1251.16 and implementing regulations:

1. (a) Assessment, Diagnostic, and Screening services; and
2. (b) Psychological Testing.

8609.3 Medicaid reimbursement will be available for the following services, when provided to an eligible Medicaid beneficiary diagnosed with a serious emotional disturbance, SMI, or SUD by a licensed behavioral health practitioner identified in § 8609.1 by a licensed behavioral health practitioner, practicing within the scope of their licensure, in accordance with requirements set forth under the District of Columbia Health Occupations Revision Act of 1985 District of Columbia Official Code Title 3, Chapter 12 §§ 3-1201.01 – 3-1213.13, 3-1251.01 – 3.1251.16 and implementing regulations:

1. (a) Counseling and Psychotherapy; and
2. (b) Treatment Planning and Care Coordination.

8609.4 Medicaid reimbursement rates for fee-for-service behavioral health services provided in accordance with this section shall be eighty percent (80%) of the rates paid by the Medicare Program. The reimbursement rates for behavioral health services shall be posted on Department of Health Care Finance’s website at

www.dc-medicaid.com and updated annually.

8609.5 For services identified in §§ 8609.2 and 8609.3, where the procedure code does not fall within the Medicare fee schedule, the methodology set forth § 8609.6 shall be used to establish the Medicaid reimbursement rate.

8609.6 DHCF shall consider the following factors to establish the Medicaid reimbursement rate for procedure codes that do not fall within the Medicare fee schedule:

(a) Practitioner fees;

(b) Fee schedules from other states;

(c) Similar procedures with established fees; or

(d) Private insurance payments.

SOURCE: Final Rulemaking published at 68 DCR 5406 (May 21, 2021).