Regulation detail

22-A8029

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22-A8029 REIMBURSEMENT

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
CMHC (60%) OUTPATIENT (60%)
Plain-English summary

This section establishes reimbursement rules for providers billing under the chapter, requiring that non-Medicaid local fund rates match equivalent Medicaid rates set by the Department of Health Care Finance. All claims for Medicaid or local-only reimbursement must include active NPI numbers for both the certified provider and the rendering (direct service) staff member.

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Regulation text
8029 REIMBURSEMENT

8029.1 Reimbursement rates using non-Medicaid local funds are equivalent to the reimbursement rates for equivalent services that may be reimbursable by Medicaid, pursuant to rates as established by the Department of Health Care Finance.

8029.2 All claims seeking Medicaid or local only reimbursement under this Chapter shall include the active NPI numbers for the certified provider and the rendering provider. The rendering provider is the staff member who provided the service.

SOURCE: Final Rulemaking published at 68 DCR 1623 (February 5, 2021); as amended by Final Rulemaking published at 69 DCR 013495 (November 4, 2022).

District of Columbia Municipal Regulations

 Mental Health
22-A DCMR § 8029