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22-A3009

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22-A3009 INDIVIDUAL PLAN OF CARE

Jurisdiction: DC Agency: DC Department of Behavioral Health (DBH) — Title 22-A; and DC Department of Health Care Finance (DHCF) — Title 29 Medicaid behavioral-health chapters
OUTPATIENT (100%)
Plain-English summary

This regulation requires each Freestanding Mental Health Clinic (FSMHC) in DC to develop, maintain, and annually review an individual plan of care for every consumer. The plan must include a mental health assessment, DSM diagnosis, treatment goals, and certification by an independently licensed behavioral health practitioner that outpatient treatment is the appropriate level of care. Facilities must also conduct functional assessments at intake, upon significant status changes, and at discharge, using age-appropriate standardized tools.

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Regulation text
3009 INDIVIDUAL PLAN OF CARE

3009.1 Each FSMHC shall develop an individual plan of care for each consumer. Copies of individual plans of care shall be filed in consumer records.

3009.2 The plans of care shall include the following:

(a) A written assessment of the consumer's current mental condition, co-occurring substance use, and physical co-morbidity; 

(b) A diagnosis by a licensed behavioral health practitioners able to diagnose in accordance with his or her professional license, using the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) currently in use by the Department;

(c) The names of the behavioral health practitioner(s) involved in the approval and direction of the plan of care;

The treatment goals, strengths, challenges, objectives, and interventions; 

The name and title of other staff who shall participate in carrying out the plan of care; and 

The independently licensed behavioral health practitioner’s certification, by dated signature: 

Of the medical necessity for all mental health services detailed in the plan; and 

That outpatient treatment is an appropriate level of care for the identified consumer.

3009.3 The plan of care shall be reviewed and amended, as needed in case of a change in the consumer’s status and at least annually by the independently licensed behavioral health practitioner. The consumer’s continuing need for treatment and medical necessity of treatment shall be clearly documented. The independently licensed behavioral health practitioner shall certify by his or her signature: 

(a) That the review occurred; 

The medical necessity for all mental health services detailed in the plan; and 

That outpatient treatment is an appropriate level of care for the identified consumer. 

3009.4 The Consumer, and/or the parent or guardian, if applicable, shall sign his or her plan of care. 

3009.5 The FSMHC shall complete a functional assessment for each consumer, utilizing the Daily Living Activities-20 assessment for consumers aged twenty-one (21) and older, the Child and Adolescent Functional Assessment Scale for consumers aged six (6) through twenty (20) and the Preschool and Early Childhood Functional Assessment Scale for consumers age (3) through (5), at the following times: 

Intake;

Upon events that may affect a consumer’s functioning and may require a change in their treatment plan or service acuity; and 

Discharge.

SOURCE: Final Rulemaking published at 67 DCR 11929 (October 16, 2020); as amended by Final Rulemaking published at 71 DCR 014542 (November 29, 2024).

District of Columbia Municipal Regulations

 Mental Health
22-A DCMR § 3009