29-5210

29-5210 ASSERTIVE COMMUNITY TREATMENT

This regulation governs Medicaid billing and service delivery requirements for Assertive Community Treatment (ACT) providers in the District of Columbia. It specifies the required service components of ACT, minimum contact thresholds (at least eight contacts per month, five of which must be face-to-face), prior authorization requirements, and restrictions on billing other services concurrently while a consumer is enrolled in ACT. Providers must deliver ACT in accordance with Chapter 34 of Title 22-A DCMR and may not bill certain overlapping services unless specific exceptions apply.

5210 ASSERTIVE COMMUNITY TREATMENT

5210.1 Assertive Community Treatment (“ACT”) services shall include: 

Completion of comprehensive and ongoing assessments and development and updating of a self-care-oriented Plan of Care (if a current and effective one does not already exist); 

Medication prescription, administration, and monitoring; 

Crisis assessment and intervention; 

Symptom assessment and management;

Individual and group counseling/therapy;

Substance use disorder treatment for consumers with a co-occurring substance use disorder; 

Psychosocial rehabilitation and skill development; 

Interpersonal social and interpersonal skill training;

Education, support, and consultation to consumers’ families and/or their support system, which is directed exclusively to the well­being and benefit of the consumer; 

Addressing social determinants of health through referrals and linkages to other services; 

Daily living skills counseling and acquisition; and 

Coordination of medical and psychosocial services.

5210.2 Assertive Community Treatment shall: 

Be billed in monthly units; 

Require at least eight (8) contacts per month for any consumer for a provider to receive reimbursement. Of those eight (8) contacts:
 
A minimum of five (5) contacts must be face to face and in person;

A maximum of three (3) contacts may be collateral contacts;

A minimum of three (3) contacts must be made by qualified practitioners, outlined in Chapter 34 of Title 22-A DCMR. One (1) of those contacts must be made by an MD/APRN and be direct to the individual (e.g., not a collateral contact or team meeting);
 
The only face to face ACT contacts that may be provided via telehealth are MD and APRN contacts;
 
Up to two (2) contacts per day may count towards the eight (8) required contacts.

Require prior authorization; and

Be delivered in accordance with the requirements set forth in Chapter 34 of Title 22-A DCMR.

5210.3 While a consumer is enrolled in ACT:

(a) Counseling/Therapy, Rehabilitation Day Services, IDT, CBI Levels 1, 2, and 3, TF-CBT, FFT, Trauma Recovery and Empowerment Services, and TST shall not be billed, unless otherwise authorized;

(b) Medication/Somatic Treatment and Community Support shall not be billed unless: 

(1) Rendered by a provider that is different from the ACT provider, in the first thirty (30) calendar days of the consumer’s enrollment into ACT or within thirty (30) calendar days prior to disenrollment from ACT; or

(2) The service is otherwise authorized; and

(c) Crisis/Emergency Services shall not be billed, unless rendered by a provider that is different from the ACT provider, in the first thirty (30) calendar days of the consumer’s enrollment into ACT or within thirty (30) calendar days prior to disenrollment from ACT.

5210.4 An ACT provider shall not bill Screening, Assessment, and Diagnosis services, unless the result of the ACT provider’s assessment is a determination that ACT services are not indicated for the consumer.

SOURCE: Final Rulemaking published at 49 DCR 4860 (May 24, 2002); as amended by Final Rulemaking published at 69 DCR 012836 (October 21, 2022); as amended by Final Rulemaking published at 71 DCR 002888 (March 15, 2024).

District of Columbia Municipal Regulations

 Public Welfare
29 DCMR § 5210