This regulation establishes reimbursement limitations for Clubhouse services under the DC Department of Behavioral Health. Clubhouse providers are reimbursed in 15-minute increments for up to 24 units per day, contingent on minimum member engagement and daily encounter documentation. Services require a Plan of Care, cannot be billed on the same day as Rehabilitation/Day Services or Intensive Day Treatment, and only one Clubhouse may be reimbursed per consumer per 180-day period.
View official source3906 DISTRICT REIMBURSEMENT LIMITATIONS 3906.1 Clubhouse treatment duration varies but generally last up to one hundred eighty (180) days. Clubhouse treatment can continue long-term in accordance with the Plan of Care for individuals experiencing ongoing rehabilitation needs. Clubhouse services may be reimbursed according to the consumer’s Human Care Agreement (HCA) with the Department and medical necessity. 3906.2 The District shall reimburse Clubhouse providers for Clubhouse services in fifteen (15) minute-increment units for up to twenty-four (24) units per day. The services will only be reimbursable if the following requirements are met: (a) The member has engaged in at least fifteen (15) minutes of Clubhouse services per day; and (b) The provider prepared a daily encounter note documenting the services provided to the member per day in accordance with § 3907.3 of this chapter. 3906.3 Clubhouse services require a Plan of Care. 3906.4 Clubhouse services may not be reimbursed for the same consumer on the same day as Rehabilitation/Day Services or Intensive Day Treatment. 3906.5 The District shall only reimburse one Clubhouse on behalf of each consumer per one hundred eighty (180) day period. 3906.6 In accordance with § 3432 of this subtitle, certain services may not be reimbursed through Medicaid. SOURCE: Emergency and Proposed Rulemaking published at 57 DCR 4010 (May 7, 2010)[EXPIRED]; as amended by Emergency and Proposed Rulemaking published at 57 DCR 7734 (August 20, 2010)[EXPIRED]; as amended by Final Rulemaking published at 57 DCR 8698, 8703 (September 24, 2010); as amended by Final Rulemaking published at 66 DCR 5638 (May 3, 2019); as amended by Final Rulemaking published at 67 DCR 10674 (September 4, 2020); as amended by Final Rulemaking published at 72 DCR 008497 (August 1, 2025). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 3906