This regulation defines and sets reimbursement eligibility conditions for three DC Medicaid mental health services delivered by MHRS providers: (1) Continuity of Care Treatment Planning in institutional settings (MHS-CTPI), (2) Discharge Treatment Planning from institutional settings (MHS-DTPI, including ACT and CBI variants), and (3) Community Psychiatric Supportive Treatment Rehab/Day Services (CPS-Rehab/Day). Operators must ensure services are delivered by qualified mental health professionals or credentialed workers through certified MHRS providers, and that all services comply with Department policies to qualify for reimbursement.
View official source5301 DESCRIPTION OF REIMBURSABLE SERVICES 5301.1 Reimbursable “Mental Health Service – Continuity of Care Treatment Planning, Institution” services (MHS-CTPI) are services to assist consumers in institutional settings. MHS-CTPI is to be used for any mental health service not for discharge treatment planning or Rehab/Day purposes provided by an MHRS provider to any consumer, including those enrolled in Assertive Community Treatment (ACT) or Community-Based Intervention (CBI) services, in an institutional setting. 5301.2 In order to be eligible for reimbursement, MHS-CTPI shall only be provided by an MHRS provider through a mental health professional or credentialed worker to a Department consumer who is in an institutional setting listed in Subsection 5300.2. 5301.3 Mental Health Service – Discharge Treatment Planning, Institution (MHS - DTPI) is a service to develop a mental health service plan for treating a consumer after discharge from an institutional setting. It includes modifying goals, assessing progress, planning transitions, and addressing other needs, as appropriate. 5301.4 In order to be eligible for reimbursement, MHS-DTPI shall only be provided by an MHRS provider through a mental health professional or credentialed worker to a Department consumer who is in an institutional setting who is not enrolled in Assertive Community Treatment (ACT) or Community-Based Intervention (CBI). 5301.5 In order to be eligible for reimbursement, MHS-DTPI (ACT) shall be provided only by a member of an MHRS Assertive Community Treatment (ACT) team to a consumer who is enrolled in ACT services and preparing for discharge from the institution setting. 5301.6 In order to be eligible for reimbursement, MHS-DTPI (CBI) shall be provided only by a member of an MHRS Community-Based Intervention (CBI) Team, all levels, to a child or youth who is enrolled in CBI and preparing for discharge from the institutional setting. 5301.7 Community Psychiatric Supportive Treatment Program – Rehab/Day Services (CPS-Rehab/Day) is a day treatment program provided in the community designed to acclimate the consumer to community living. 5301.8 In order to be eligible for reimbursement, CPS-Rehab/Day Services shall only be provided by a certified MHRS Rehabilitation/Day Services provider. 5301.9 All services must be provided in accordance with Department policies regarding care to consumers to be eligible for reimbursement. SOURCE: Final Rulemaking published at 61 DCR 3787 (April 11, 2014). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 5301