This section establishes reimbursement rates for the DC Department of Behavioral Health (DBH) for services provided under Title 22-A DCMR Chapter 63, directing that non-Medicaid beneficiaries be reimbursed at the same rates as the DC Medicaid fee schedule. It specifies local-only substance use service rates including Multi-Systemic Therapy for Transition Age Youth, Residential Room and Board (including women with children), and Environmental Stability/Supported Housing. It also sets reimbursement rates for ancillary testing services (HIV, pregnancy, TB, hepatitis C, and drug testing) for non-Medicaid clients, and requires public notice and comment before future rate updates.
View official source6401 REIMBURSEMENT RATE 6401.1 The Department of Health Care Finance has published rates for Medicaid-funded services under Title 22-A District of Columbia Municipal Regulations (DCMR), Chapter 63. Those rates are contained in the District of Columbia Medicaid fee schedule available online at HYPERLINK "http://www.dc-medicaid.com" www.dc-medicaid.com . The Department of Behavioral Health (“the Department”) shall reimburse providers for Chapter 63 services provided to non-Medicaid beneficiaries at the same rates as contained in the District of Columbia Medicaid fee schedule. 6401.2 Reimbursement for the local-only substance use services provided under Title 22-A DCMR Chapter 63, which include: (a) Multi-systemic Therapy for Transition Age Youth and (b) Environmental Stability, as well as Chapter 63-adjacent (c) Residential Room and Board, are set forth in the table below. The Department shall publish notice of all future updates to these codes and rates through a Public Notice in the D.C. Register and provide for meaningful comment before implementation. The Notice shall describe the type of change, the reason for the change, the effective date of the change, and the new local only reimbursement rate. SERVICE CODE RATE per UNIT ($) UNIT Multi-Systemic Therapy for Transition Age Youth (TAY) (ACRA) (Ages 21-24) H2033HF 63.11 15 min. Residential Treatment, Room & Board H0043 101.14 Per diem Residential Treatment, Room & Board, Woman w/1 child H0043UN 210.00 Per diem Residential Treatment, Room & Board, Woman w/2 children H0043UP 215.00 Per diem Residential Treatment, Room & Board, Woman w/3 children H0043UQ 220.00 Per diem Residential Treatment, Room & Board, Women w/4 or more children H0043UR 225.00 Per diem Environmental Stability, Supported Housing, Individual H0044HF 849.00 Per month Environmental Stability, Supported Housing, Woman w/children H0044HFUN 1000.00 Per month 6401.3 Reimbursement for the following tests provided to non-Medicaid clients shall be the rate contained in the District of Columbia Medicaid fee schedule available online at HYPERLINK "http://www.dc-medicaid.com" www.dc-medicaid.com : (a) HIV-1 and HIV-2 Single Result Testing (86703); (b) Urine Pregnancy Test (81025); (c) Tuberculosis Test, Intradermal (86580); (d) Hepatitis C Test (86803); (e) Presumptive Drug Test, Optical Observation (80305); (f) Presumptive Drug Test, Assisted Direct Optical Observation (80306); and (g) Presumptive Test by Instrument Chemistry Analyzers (80307). 6401.4 Reimbursement for the following tests provided to non-Medicaid clients shall be the rate contained in the District of Columbia Medicaid fee schedule available online at HYPERLINK "http://www.dc-medicaid.com" www.dc-medicaid.com : (a) Definitive Drug Testing 1-7 Drug Classes (G0480); and (b) Definitive Drug Testing 8-14 Drug Classes (G0481). 6401.5 All future updates to the service codes and rates will be included in the District of Columbia Medicaid fee schedule pursuant to the procedures established in Title 29 DCMR, Section 988, by providing notice and an opportunity for comment. SOURCE: Final Rulemaking published at 63 DCR 6936 (May 6, 2016); as amended by Final Rulemaking published at 66 DCR 2322 (February 22, 2019); as amended by Final Rulemaking published at 67 DCR 11430 (October 2, 2020). District of Columbia Municipal Regulations Mental Health 22-A DCMR § 6401