This regulation establishes Medicaid reimbursement rates for specific mental health services provided to consumers transitioning out of institutional settings, including continuity-of-care treatment planning, discharge treatment planning (for general, ACT, and CBI consumers), and Community Psychiatric Supportive Treatment (day/rehab services). Facility operators must bill using the specified HCPCS codes, rates, and unit limits, with some services requiring prior authorization based on medical necessity. Several services are explicitly tied to discharge from an institution, and the CPS Rehab/Day service is limited to sixty days post-discharge unless a court order applies.
View official source5302 REIMBURSEMENT RATE 5302.1 The rates for reimbursement are as set forth below: CODE SERVICE RATE UNIT UNITS AUTHORIZED H0032HK Mental Health Service – Continuity of Care Treatment Planning, Institution for all MHRS consumers (MHS-CTPI) $21.97 15 minutes Up to 24 units within 180 days without prior authorization for continuity of care services H0032 Mental Health Service – Discharge Treatment Planning, Institution for all consumers except those in ACT or CBI (MHS-DTPI) $21.97 15 minutes Based on medical necessity at time of authorization, for discharge planning. H0046HT Mental Health Service – Discharge Treatment Planning, Institution -ACT consumers (MHS-DTPI(ACT)) $38.04 15 minutes Based on medical necessity at time of authorization for discharge planning. H0046HTHA Mental Health Service – Discharge Treatment Planning, Institution – CBI consumers (MHS-DTPI (CBI)) $35.74 15 minutes Based on medical necessity at time of authorization for discharge planning. H0037 Community Psychiatric Supportive Treatment Program – Rehab/Day Services (CPS – Rehab/Day) $123.05 Per day, at least 3 hours Based on medical necessity at time of authorization; only within sixty (60) days of discharge unless pursuant to court order. SOURCE: Final Rulemaking published at 61 DCR 3787 (April 11, 2014). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 5302